Healthcare
NPR had a really good Noon interview yesterday, talking to the author of a new article in the New England journal of Medicine detailing the plans of both John McCain and Barack Obama.
You can find the article here, but I will summarize the policies below.
John McCain’s main goal is make insurance cheaper by reducing the coverage offered. Everyone will be given $2,500 in tax credits to buy their own insurance on the individual market. Individuals will also be able to buy insurance across state lines, allowing insurers to move to states without mandatory requirements for coverage or insures to buy cheaper insurance that covers less. This will make insurance cheaper (within the $2500), however $2,500 only buys you catastrophic coverage (deductibles of ~$10,000 or more). Because the tax credits are to the individual, health benefits from employers would no longer be tax exempt which is suggested in the article to lead to many companies dropping the now more expensive (because they would have to pay taxes on it) employee health insurance.
The author admitted during the interview that McCain himself would not be insurable under this plan, as he has many preexisting conditions and suffers from old. So his premiums for even basic coverage would be enormous or not offered at all. McCain’s answer to this is to create a guaranteed program run by the states with some help by the Feds. Even though the author explains briefly that with the experiences of 34 states that run a guaranteed program, most suffer the same problems as the individual health care market.
Barack Obama’s plan involves creating what they call a “play or pay” system for large employers. Either the gives employees the option of health care, or they pay a tax which would fund the creation of a group insurance system for individuals and small business to buy into. This would be a dual public-private entity like Medicare and the Massachusetts Connecter program. Subsidies will be provided to help lower income insures, and companies could not turn anyone down due to previous conditions. There will no longer be a medical write-down due to the consumers’ health condition. He also plans to institute a program in which small companies can be reimbursed for expenses stemming from catastrophic coverage on one of their employees. In effect, these reforms are meant to spread out the risk of insurance as broadly as possible in order to decrease premiums overall.
The problem with this plan is paying for it. The plan would shift the cost of catastrophic cases (50-60 billion) from individuals and businesses to the government. Obama plans on using savings wrought from reformed administrative costs and from better care, and by letting the bush tax cuts for those who make over $250,000 expire. However, unless the cost savings are realized, the bush tax cut expiration cannot be used. According to CBO (congressional budget office) rules, the entire tax cut expiration is already planned in expiring, with deficits still present. So new spending must come from somewhere else. However, that never seemed to stop wars or other “necessary” projects before, so this seems more like a political problem than anything else. I mean hell, McCain plans on making the bush tax cuts permanent while cutting taxes a shit-load more for the uber-rich. I would like health benefits more.
Both campaigns want to save money by instituting administrative reforms in the fed Medicare/Medicaid programs. Even though Obama is the only one who specifically details what those reforms would look like (you can check that out at his website if you want). McCain, like everything else, has extremely vague proposals. I can kind of understand though, the president does not actually write law, and with an assured democratic legislative branch, I doubt they would listen to him at all anyways.
Now I may be a little biased, but I think that Obama’s plan is better. The main issue I see is preemptive medical care. If you have insurance that has a huge deductible, it is very unlikely that you will go to the doctors very often, if at all. Even if your “credit” covers the cost of your insurance, we all know what it is like trying to go to a doctor with no coverage, which is pretty much what catastrophic coverage is. Instead of taking care of these minor problems immediately when it is cheaper, you would probably wait, hoping for it to go away on its own until you are forced to go to the doctors via the emergency room because whatever small problem existed has now turned into a massive, life threatening one, which will probably cost way more in health and money that whatever little problem was there at the beginning.