The Future of Health Care in America

The election is coming, and one issue very much on the minds of the public is health care. Everyone agrees that it’s a mess, with 47 million Americans uninsured and many millions more underinsured, health care costs that are skyrocketing and the lack of preventive services. But although the issues are clear, the solutions proposed are very different. What will the future of health care hold? Let’s take a look at health care under Obama, versus health care under McCain.

Obama wants to create a national health plan giving individuals the choice to buy affordable health coverage that is similar to the plan available to federal employees. This plan would be open to all Americans, including the self-employed and small businesses that want to offer insurance to their employees. This plan will include guaranteed eligibility. No one will be turned away from any insurance plan because of pre-existing conditions. It will also include comprehensive benefits, including all essential medical services, preventive services, maternity benefits and mental health care. Coverage will also include disease management programs, self-management training and care coordination for appropriate individuals.

Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services. There will be subsidies for those who do not qualify for Medicaid or SCHIP (State Children’s Health Insurance Program) but still need assistance. The plan will simplify paperwork to help reign in health costs, and will have easy enrollment and provide ready access to coverage.

Those in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage. This is known as portability.

Participating hospitals and providers will be required to collect and report data to ensure that standards for health care quality, technology and administration are being met. The Exchange would also evaluate plans and make their differences and costs transparent.

To provide Americans with more options, a National Health Insurance Exchange will be created. The Exchange will act as a watchdog to reform the private insurance market by creating and instituting rules and standards to ensure fairness and make individual coverage more affordable and accessible.

It will also help those who wish to purchase a private insurance plan. Through the Exchange, any American can choose to enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need it. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend on health status. Private plans would be required to offer benefits that are at least as generous as the new public plan and meet the same standards for quality and efficiency.

Employers who do not offer meaningful coverage or contribute to the cost of health care for their employees will be required to contribute a percentage of payroll towards the national plan. Small employers below a certain threshold would be exempt. The Obama plan would also reimburse employer health plans for a portion of costs in case of a catastrophic illness in an employee if they guarantee that the savings would be used to reduce the cost of workers’ premiums.

There will be mandatory health care coverage for all children, and young adults up to the age of 25 can continue coverage through their parents’ plans.

Eligibility for Medicaid and SCHIP would be expanded. State health care plans would not be replaced, provided they meet the minimum standards of the national plan.

These are the main points of the Obama health care plan. This health care plan would cost $50-65 billion a year when fully phased in. Savings within the health care system will help finance the plan. The rest will be covered by allowing the Bush tax cuts for people making over $250,000 a year to expire, as they are scheduled to do. For the full health care plan, or a “Frequently Asked Questions” summary, go to: www.barackobama.com/issues/healthcare/.

McCain’s Plan

McCain’s proposed health care plan is considerably more difficult to lay out in concrete terms because most of the proposals do not go into details and are cautious in committing to specifics. Here are the main points:

McCain’s plan will use competition in the marketplace to improve the quality of health insurance.

Part of the plan would reform the tax code, eliminating tax breaks for employers who provide health insurance for their workers and giving instead up to $5,000 in tax credits to families to buy their own health insurance (see competition in the marketplace above). Note: Nationwide, the average cost of a family policy was $12,106 in 2007.1 Also, see hidden costs.2

McCain will encourage and expand the benefits of Health Savings Accounts (HSAs 3) for families.

This health plan also proposes to make insurance more portable by allowing insurance to follow the individual from job to job.

McCain says he will work with governors of individual states to develop a “best practice model” and a Guaranteed Access Plan (GAP) that “would reflect the best experience of the states to ensure these patients have access to health coverage.” States would be encouraged to create high-risk pools that would contract with insurers to cover consumers who have been rejected on the open market.

The plan suggests “re-importing” drugs from other countries and the faster introduction of generic drugs to lower drug prices and promote greater competition.

The plan also calls for promoting coordinated care, expanding access to heath care, promoting the availability of smoking cessation programs, encouraging states to lower costs, and bringing transparency to health care.

McCain suggests that emphasizing prevention, early intervention, healthy habits and new treatment models will cut the costs of care for chronic diseases.

The plan would reform the payment systems in Medicaid and Medicare to cut costs. Providers would be compensated for diagnosis, prevention and care coordination, and Medicaid and Medicare would not pay for preventable medical errors or mismanagement.

McCain wants medical liability reform that eliminates lawsuits directed at doctors who follow clinical guidelines and adhere to safety protocols.

Long-Term Care: McCain talks about “developing a strategy for meeting the challenge of a population needing greater long-term care.” He cites state-based programs such as “Cash and Counseling” and “The Program of All-Inclusive Care for the Elderly” (PACE) but does not commit to any specific strategy.

Funding the plan: McCain believes his tax cuts will cancel out the cost of his tax refunds over 10 years. As to funding for the rest of his plan, McCain says he will work with Congress, the governors and industry. For more information from McCain’s website, go to: http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm.

Summary

So what does all this boil down to? Tony Pugh of McClatchy Newspapers states, “Obama's proposed universal health-care plan embodies the long-held Democratic Party goal of covering the 47 million Americans who lack health insurance. Employers, insurers, individuals and the government all would have greater roles in assuring coverage through a number of proposals designed to close gaps in the system. McCain's plan takes a different approach. It follows Republican orthodoxy of trying to make the private-insurance marketplace more affordable and competitive by radically altering the tax treatment of health-care benefits.”4

But McCain’s proposals raise concerns on who will be covered and how well. Paul Ginsburg, the president of the Center for the Study of Health System Change said of McCain’s proposed tax changes, “If that tax exclusion is no longer allowed and all I get is a tax credit for $5,000, well, maybe I'll decide a (cheaper) policy is all I need or all I can afford. I'll get less health insurance, which means I'm going to be paying more of the cost of care…”4 Mark Pauly, a health-care management professor at the Wharton School of the University of Pennsylvania said of McCain’s tax credits, “At [today’s] prices, the credits likely could pay only for catastrophic coverage.”4

And what about those individuals with pre-existing conditions, the sick and the elderly? Elizabeth Edwards, (wife of former Democratic presidential contender John Edwards) who is now fighting cancer, said she and John McCain have one thing in common: “neither one of us would be covered by his health policy.”5

Health Care Campaign Plans – Online Info

Endnotes

1 The Kaiser Family Foundation, “Average Annual Worker and Firm Premium Contributions and Total Premiums for Covered Workers for Single and Family Coverage, by Plan Type, 2007.”

2 The 71 percent of insured Americans who get their health coverage through their employers now enjoy a significant advantage because the money spent by employers on their health coverage is excluded from their taxable income. If employers chose to pay that share of a worker’s compensation as wages rather than benefits, the income would be taxable. McCain Health Plan Could Mean Higher Tax (NY Times 5/1/08)

3 HSAs are accounts where the individual or family can put pre-tax dollars to be used for health care expenses not covered by their insurance. As long as the money is used for approved medical expenses it is not taxed. HSAs are only offered with HSA-eligible high-deductible health plans. High Deductible Health Plans are health plans with a minimum deductible (as of 2007) of $1,100 per individual or $2,200 per family.

4 McClatchy Newspapers, “McCain, Obama Offer Vastly Different Health Care Plans.” 6/10/08.

5 LA Times, “McCain’s health plan fails her test.” 3/30/08.




	Send to a friend Obama vs. McCain - The Future of Health Care in America by Laurie Long 6/08 The election is coming, and one issue very much on the minds of the public is health care. Everyone agrees that it’s a mess, with 47 million Americans uninsured and many millions more underinsured, health care costs that are skyrocketing and the lack of preventive services. But although the issues are clear, the solutions proposed are very different. What will the future of health care hold? Let’s take a look at health care under *Obama, versus* health care under *McCain. Obama’s Plan* Obama wants to create a *national health plan* giving individuals the choice to buy affordable health coverage that is similar to the plan available to federal employees. This plan would be open to all Americans, including the self-employed and small businesses that want to offer insurance to their employees. This plan will include guaranteed eligibility. *No one will be turned away from any insurance plan because of pre-existing conditions.* It will also include *comprehensive benefits, including all essential medical services, preventive services, maternity benefits and mental health care. Coverage will also include disease management programs,* self-management training and care coordination for appropriate individuals. Participants will be charged *fair premiums* *and minimal co-pays* for deductibles for preventive services. There will be *subsidies* for those who do not qualify for Medicaid or SCHIP (State Children’s Health Insurance Program) but still need assistance. The plan will simplify paperwork to help reign in health costs, and will have *easy enrollment* and provide ready access to coverage. Those in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage. This is known as *portability. Participating hospitals and providers will be required to collect and report data to ensure that standards for health care quality, technology and administration are being met. The Exchange would also evaluate plans and make their differences and costs transparent. To provide Americans with more options, a National Health Insurance Exchange* will be created. The Exchange will act as a watchdog to reform the private insurance market by *creating and instituting rules and standards* to ensure fairness and make individual coverage more affordable and accessible. It will also help those who wish to purchase a private insurance plan. Through the Exchange, any American can choose to enroll in the new public plan or purchase an approved *private plan, and income-based sliding scale subsidies* will be provided for people and families who need it. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend on health status. Private plans would be required to offer benefits that are at least as generous as the new public plan and meet the same standards for quality and efficiency. Employers who do not offer meaningful coverage or contribute to the cost of health care for their employees will be required to contribute a percentage of payroll towards the national plan. Small employers below a certain threshold would be exempt. The Obama plan would also *reimburse employer health plans* for a portion of costs in case of a *catastrophic illness* in an employee if they guarantee that the savings would be used to reduce the cost of workers’ premiums. There will be *mandatory health care coverage for all children, and young adults up to the age of 25 can continue coverage through their parents’ plans. Eligibility for Medicaid and SCHIP would be expanded.* State health care plans would not be replaced, provided they meet the minimum standards of the national plan. These are the main points of the Obama health care plan. This health care plan would cost $50-65 billion a year when fully phased in. Savings within the health care system will help finance the plan. The rest will be covered by allowing the Bush tax cuts for people making over $250,000 a year to expire, as they are scheduled to do. For the full health care plan, or a “Frequently Asked Questions” summary, go to: www.barackobama.com/issues/healthcare/. McCain’s Plan McCain’s proposed health care plan is considerably more difficult to lay out in concrete terms because most of the proposals do not go into details and are cautious in committing to specifics. Here are the main points: McCain’s plan will use *competition in the marketplace* to improve the quality of health insurance. Part of the plan would *reform the tax code,* eliminating tax breaks for employers who provide health insurance for their workers and giving instead up to $5,000 in *tax credits* to families to buy their own health insurance (see competition in the marketplace above). Note: Nationwide, the average cost of a family policy was $12,106 in 2007.1 Also, see hidden costs.2 McCain will *encourage and expand the benefits of Health Savings Accounts* (HSAs 3) for families. This health plan also proposes to *make insurance more portable* by allowing insurance to follow the individual from job to job. McCain says he will work with governors of individual states to develop a “best practice model” and a *Guaranteed Access Plan* (GAP) that “would reflect the best experience of the states to ensure these patients have access to health coverage.” States would be encouraged to create *high-risk pools* that would contract with insurers to cover consumers who have been rejected on the open market. The plan suggests “re-importing” drugs from other countries and the faster introduction of generic drugs to *lower drug prices* and promote greater competition. The plan also calls for promoting *coordinated care, expanding access to heath care, promoting the availability of smoking cessation programs, encouraging states to lower costs, and bringing transparency* to health care. McCain suggests that emphasizing prevention, early intervention, healthy habits and new treatment models will *cut the costs of care for chronic diseases. The plan would reform the payment systems in Medicaid and Medicare* to cut costs. Providers would be compensated for diagnosis, prevention and care coordination, and Medicaid and Medicare would not pay for preventable medical errors or mismanagement. McCain wants *medical liability reform* that eliminates lawsuits directed at doctors who follow clinical guidelines and adhere to safety protocols. *Long-Term Care: McCain talks about “developing a strategy for meeting the challenge of a population needing greater long-term care.” He cites state-based programs such as “Cash and Counseling” and “The Program of All-Inclusive Care for the Elderly” (PACE) but does not commit to any specific strategy. Funding the plan:* McCain believes his tax cuts will cancel out the cost of his tax refunds over 10 years. As to funding for the rest of his plan, McCain says he will work with Congress, the governors and industry. For more information from McCain’s website, go to: http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm. Summary So what does all this boil down to? Tony Pugh of McClatchy Newspapers states, “Obama's proposed universal health-care plan embodies the long-held Democratic Party goal of covering the 47 million Americans who lack health insurance. Employers, insurers, individuals and the government all would have greater roles in assuring coverage through a number of proposals designed to close gaps in the system. McCain's plan takes a different approach. It follows Republican orthodoxy of trying to make the private-insurance marketplace more affordable and competitive by radically altering the tax treatment of health-care benefits.”4 But McCain’s proposals raise concerns on who will be covered and how well. Paul Ginsburg, the president of the Center for the Study of Health System Change said of McCain’s proposed tax changes, “If that tax exclusion is no longer allowed and all I get is a tax credit for $5,000, well, maybe I'll decide a (cheaper) policy is all I need or all I can afford. I'll get less health insurance, which means I'm going to be paying more of the cost of care…”4 Mark Pauly, a health-care management professor at the Wharton School of the University of Pennsylvania said of McCain’s tax credits, “At [today’s] prices, the credits likely could pay only for catastrophic coverage.”4 And what about those individuals with pre-existing conditions, the sick and the elderly? Elizabeth Edwards, (wife of former Democratic presidential contender John Edwards) who is now fighting cancer, said she and John McCain have one thing in common: “neither one of us would be covered by his health policy.”5 Health Care Campaign Plans – Online Info 2008 Presidential Health Care Proposals: Side-by-Side Summary (Kaiser Family Foundation) http://www.barackobama.com/issues/healthcare/ http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm McCain, Obama lay out plans for economy (Associated Press 7/8/08) Obama and McCain: two sides of the coin (LA Times 6/15/08) McCain, Obama offer vastly different health care plans (McClatchy Wa. Bureau 6/10/08) Obama, McCain and Health Care Reform (Managed Care Matters 6/10/08) McCain’s Health Care Spending Doubles Obama And Clinton (Think Progress 5/1/08) McCain Health Plan Could Mean Higher Tax (NY Times 5/1/08) McCain's Health Care Plan (Economists for Obama 4/30/08) Tax credits at heart of McCain’s health care proposal (CNN 4/29/08) McCain’s health plan fails her test (LA Times 3/30/08) Obama Offers Health Care Plan (NY Times 5/29/07) Also of Interest: Obama's Plan for People with Disabilities Endnotes 1 The Kaiser Family Foundation, “Average Annual Worker and Firm Premium Contributions and Total Premiums for Covered Workers for Single and Family Coverage, by Plan Type, 2007.” 2 The 71 percent of insured Americans who get their health coverage through their employers now enjoy a significant advantage because the money spent by employers on their health coverage is excluded from their taxable income. If employers chose to pay that share of a worker’s compensation as wages rather than benefits, the income would be taxable. McCain Health Plan Could Mean Higher Tax (NY Times 5/1/08) 3 HSAs are accounts where the individual or family can put pre-tax dollars to be used for health care expenses not covered by their insurance. As long as the money is used for approved medical expenses it is not taxed. HSAs are only offered with HSA-eligible high-deductible health plans. High Deductible Health Plans are health plans with a minimum deductible (as of 2007) of $1,100 per individual or $2,200 per family. 4 McClatchy Newspapers, “McCain, Obama Offer Vastly Different Health Care Plans.” 6/10/08. 5 LA Times, “McCain’s health plan fails her test.” 3/30/08.
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Obama vs. McCain - The Future of Health Care in America

McCain’s Plan

Summary

Health Care Campaign Plans – Online Info

Obama vs. McCain -
The Future of Health Care in America