Obama vs. McCain – Health Care

By Vidya Pradhan 

Health care has always been the domain of the Democrats, in particular, Senator Hillary Clinton, who got herself in political hot water after her abortive attempts at health care reform during the Clinton presidency. Democrats have always attempted to craft a health care plan that makes it possible for every individual to be covered by offering access to a variety of plans. By contrast, Republicans build their health care plans based on individual choice and personal responsibility. GOP conservatives have traditionally opposed legislation expanding government funded health care on the principle of smaller government. In 1965, when Medicare and Medicaid were signed into law by President Johnson, it was a bitter loss to the Republican fight against a nationalized health care system.

Today there is general consensus that the American health care system is in serious need for reform – on one hand, 47 million Americans do not have any medical insurance; on the other, crippling health care costs are making American industry uncompetitive. The path to reform is where the candidates diverge sharply. While Senator Obama talks about expanding coverage to include most Americans by way of a national health plan, Senator McCain emphasizes Health Savings Accounts, accounts to which families and individuals contribute to save towards medical expenses. The idea is that the burden should be lifted from employers and transferred to the individual, who would take control of his or her own health plan.

UPDATE: An article from the NYT about the McCain Health Care Plan.

UPDATE II: The conservative Wall Street Journal (!) comes out with an article entitled "Why Obama's Health Care Plan is better" An excerpt –

Sen. Obama's proposal will modernize our current system of employer- and government-provided health care, keeping what works well, and making the investments now that will lead to a more efficient medical system.

The McCain plan is a big tax increase on employers and workers. With the economy in recession, that's the last thing America's businesses need.

…Mr. McCain does nothing to bend the curve of rising health-care costs downward. He does not fund investments in learning, rewarding and preventing. Eliminating state coverage requirements will slash preventive service availability.

Here is a chart from the Urban/BrookingsTax Policy Center that breaks down the impact each candidates' plans would have on the uninsured.( H/T to Yglesias at Think Progress)

Barack Obama


•    Quality, Affordable and Portable Coverage for All through a national plans that gives guaranteed coverage and benefits similar to members of Congress.
•    Create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan.
•    Mandatory coverage of children
•    Lower Costs by Modernizing The U.S. Health Care System
•    Promoting prevention and public health
•    Insurance reform
•    Will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. Obama will also repeal the ban that prevents the government from negotiating with drug companies.
•    Committed to improving mental health care, supporting children with autism and reducing the risk of lead poisoning.

Voting record
•    No need to mandate coverage; just let people afford it. (Jul 2007)
•    Voted NO on means-testing to determine Medicare Part D premium. (Mar 2008)
•    Voted YES on requiring negotiated Rx prices for Medicare part D. (Apr 2007)
•    Voted YES on expanding enrollment period for Medicare Part D. (Feb 2006)
•    Voted YES on increasing Medicaid rebate for producing generics. (Nov 2005)
•    Voted YES on negotiating bulk purchases for Medicare prescription drug. (Mar 2005)
•    In 2003, Barack Obama sponsored and passed legislation that expanded health care coverage to 70,000 kids and 84,000 adults.
•    Obama cosponsored the Healthy Kids Act of 2007 and the State Children's Health Insurance Program (SCHIP) Reauthorization Act of 2007

On the costs and savings of his plan: “My plan emphasizes lowering costs, not only setting up a government plan so that people who don't have health insurance can buy into it and will get subsidized, but also making sure that those who have health insurance but are struggling with rising co-payments, deductibles, premiums. Under Bush, families are paying 78% more on health care than they were previously. We put in a catastrophic re-insurance plan that will help reduce those premiums for families by an average of about $2,500 per year. Every expert that's looked at this has said there is not a single person out there who's going to want health care who will not get it under my plan. My plan also says children will be able to stay on the parents' plan up until the age of 25.” Jan, 2008. Democratic Presidential debate.

John McCain

•    Believes the key to health care reform is to restore control to the patients themselves.
•    Use competition to improve the quality of health insurance with greater variety to match people's needs, lower prices, and portability.
•    Reform the tax code to offer more choices beyond employer-based health insurance coverage. While still having the option of employer-based coverage, every family will receive a direct refundable tax credit – effectively cash – of $2,500 for individuals and $5,000 for families to offset the cost of insurance.
•    Encourage and expand the benefits of Health Savings Accounts (HSAs) for families.
•    Look to bring greater competition to our drug markets through safe re-importation of drugs and faster introduction of generic drugs.
•    Reduce health care costs by emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure and the use of information technology.

Voting record

•    Voted against the Webb amendment calling for adequate troop rest between deploy
ments – (September 2007)
•    Voted against an amendment that would provide $20 million to the Department of Veterans Affairs (VA) for health care facilities. (May 2006.)
•    One of only 13 Senators to vote against $430,000,000 for the Department of Veteran Affairs for Medical Services for outpatient care and treatment for veterans. (April 2006)
•    Voted against increasing Veterans medical services funding by $1.5 billion in FY 2007 to be paid for by closing corporate tax loopholes. (March 2006)

•    Voted to allow appealing HMO decisions externally & in court. (Jul 1999)
•    Voted NO on expanding enrollment period for Medicare Part D. (Feb 2006)
•    Voted YES on increasing Medicaid rebate for producing generics. (Nov 2005)
•    Voted YES on negotiating bulk purchases for Medicare prescription drug. (Mar 2005)
•    Voted NO on $40 billion per year for limited Medicare prescription drug benefit. (Jun 2003)
•    Voted YES on allowing re-importation of Rx drugs from Canada. (Jul 2002)
•    Co-sponsored the Combating Autism Act of 2006 to increase public awareness and screening of autism spectrum disorder, promote the use of evidence-based interventions, and create autism Centers of Excellence for Autism Spectrum Disorder Research and Epidemiology.


About the impact on services from his plan: In an exchange with the Dallas Morning News, McCain health policy adviser John Goodman admitted that McCain’s plan to give families $5,000 to buy health insurance would drive Americans into scantier coverage. August, 2008.
About switching from employer-based health care to individual sponsored care: “Last year, the Medicaid inflation was 10%. No program in the world can survive under that. So of course we want to remove the employer tax, and tax incentives, and move it to the individual. Give the individual a $2,500 refundable tax credit, a family a $5,000 tax credit. If you need to have people in special categories such as congenital diseases, we may have to set up a fund to care for those. But the key is, make health care in America affordable and available. Don't destroy it, as the Democrats want to do.” October 2007 Republican Presidential debate.
On the problem with health care in America: “The problem with health care in America, it's not the quality. It is the inflation. In all due respect to your expert that we just saw, he's talking about the wrong aspect of this issue. The right aspect of this issue is inflation, if we could get it under control and get it reduced so that health care costs are reasonable, then those people will be able to afford it. They will be able to go out and choose their insurer, and they will be able to then to get affordable health care.” January 2008, Republican primary debate.

Says the New York Times:

"Mr. McCain’s health care plan would shift the emphasis from insurance provided by employers to insurance bought by individuals, to foster competition and drive down prices. To do so he is calling for eliminating the tax breaks that currently encourage employers to provide health insurance for their workers, and replacing them with $5,000 tax credits for families to buy their own insurance.

His proposal to move away from employer-based coverage was similar to one that President Bush pushed for last year, to little effect. And his call for expanding coverage through market-based competition is in stark contrast to the Democrats’ proposals to move toward universal health care coverage, with government subsidies to help lower-income people afford their premiums."

UPDATE: A Wall Street Journal piece by Jason Furman and Austan Goolsbee, economic policy advisors for Obama, highlights the policy detail McCain prefers to downplay.    "…Sen. McCain’s plan does include one new proposal that would result in higher taxes on the middle class. As even Sen. McCain’s advisers have acknowledged, his health-care plan would impose a $3.6 trillion tax increase over 10 years on workers.   

Sen. McCain’s plan will count the health care you get from your employer as if it were taxable cash income. Even after accounting for Sen. McCain’s proposed health-care tax credits, this plan would eventually leave tens of millions of middle-class families paying higher taxes. In addition, as the Congressional Budget Office has shown, this kind of plan would push people into higher tax brackets and increase the taxes people pay as their compensation rises, raising marginal tax rates by even more than if we let the entire Bush tax-cut plan expire tomorrow. "

Regardless of the plans the two candidates have detailed, given the partisan gridlock in Congress, it is unlikely that any significant progress will be made unless a massive bi-partisan effort is made to address this crucial issue. 

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