A short comparison of the healthcare plans - McCain vs. Obama
by: Bob Gentry
Thu Oct 16, 2008 at 16:10:32 PM MDT
Health care reform is admittedly a complex issue, but it is not so esoteric as to preclude learning the facts and arriving at one's own considered opinions. I attended a talk at St. Pat's, Missoula, on Tuesday night by Dr. Anne Murphy on this very issue. It was very informative. I wrote this without consulting Dr. Murphy, and my apologies to Dr. Murphy for mistakes and misstatements.
As stated by Dr. Murphy (and I paraphrase):
Whether a right, privilege or obligation, quality, accessible and affordable healthcare is a utility, not a luxury. It is essential to opportunity.
Bob Gentry :: A short comparison of the healthcare plans - McCain vs. Obama
This essential aspect of opportunity is denied to over 48 million uninsured Americans right now. An additional 48 million are underinsured - meaning one major illness could result in bankruptcy (healthcare costs being the single highest cause of bankruptcy in the US). And an astounding
32% of all Americans under 65 (the "working class") are uninsured. In the US in 2006, Americans spent an average of $7,000 per person out-of-pocket for healthcare, more than twice the average out-of-pocket expenditures in other "developed" countries. The US has the fastest rising costs of healthcare of any of these countries, outpacing growth of GDP and personal income.
The nuts and bolts of healthcare reform must begin with an understanding of the state of healthcare insurance in the US and the devastating effect on all of us of this situation. Actual reform efforts must be judged based on the specific whys and hows of the healthcare system. Dr. Murphy provided excellent information regarding these questions, but as she said, to discuss healthcare reform in one hour is just a start.
Additionally, Dr. Murphy briefly outlined the healthcare proposals of the presidential candidates. Briefly:
John McCain proposes to eliminate the current tax exclusion for employer sponsored insurance so that employer sponsored health insurance contributions will be taxed as income - then tax credits of $5,000 per family, $2,500 per individual would be allowed to offset healthcare expenditures. Insurance markets would be deregulated so that you could buy your healthcare from any insurance provider anywhere, basically, without regulation by the state auditor as is the present case. McCain would further guarantee access to health care for a "high risk pool," but this would have to be state funded and in a deregulated insurance industry imagine the cost of mandating states to pay insurance companies for policies on people they would much rather reject for coverage. The Economic Policy Institute estimates that
McCain's proposal would result in an additional 5% of coverage for presently uninsured Americans. It's presently unclear where the funding for McCain's plan would come from,
and it's quite possible that a large number of medium size employers would drop insurance plans altogether. The cost of McCain's proposal is $1.3 trillion over 10 years.
Barack Obama proposes an employer mandate to offer health insurance or pay additional taxes with a small business exemption and the creation of a national health pool for individuals and small businesses. Obama would mandate coverage for children, all of them. Children are among the least expensive to insure, the state of Massachusetts already does this, but there are questions about enforcement of this provision. Obama would further institute insurance reform through ending risk rating based on age, gender and health status. Many people, after leaving group coverage through an employer, simply cannot get health insurance now based on these actuarial factors.
Obama further proposes a federal reinsurance program for catastrophic cases that, in the present state of underinsurance, is the highest factor in causing bankruptcies in the US. And Obama's has a plan for financing his program, payroll taxes and ending tax cuts to >$250,000.00 wage earners. EPI estimates that
Obama's plan would cover an additional 47% of the presently uninsured Americans, it would offer private vs. public plan options, insurance pooling (moving toward single payer plan) would give a bit more power to the insured, and the cost is estimated at $1.6 trillion over 10 years.
As further pointed out by Dr. Murphy, neither of these plans provides universal health care coverage, neither is a single-payer system, and the US will probably remain last in a ranking by the Commonwealth Fund of "developed" countries in health care efficiency, equity and access for some time. But this type of change must of necessity be phased-in and bi-partisan. It is essential that Americans develop more realistic and more informed expectations about healthcare. Education is essential, facts are essential. If the goal of health care in the US is not full coverage, universal healthcare, then it's simply not going to happen.