PUBLIC HEALTH
March 26, 2008

Healthcare Reform: Universal Coverage?

There is one thing all three candidates agree on: too many Americans lack adequate health coverage.

With the field of presidential candidates narrowed down from several dozen to three — John McCain, Hillary Clinton and Barack Obama — now seems like a good time for TheDoctor to examine their proposals for health care reform. In a series of four articles, we will be exploring the candidates' plans for health care in the following areas: how they propose to deal with those people who are uninsured; how they intend to contain drug and other costs; how they view Medicaid, Medicare and other entitlements; and finally, those specific proposals that are unique to each candidate's plan.

There is one thing all three candidates agree on: too many Americans lack adequate health coverage. But they differ in how they would treat America's estimated 40-50 million uninsured — whether they'd demand the uninsured buy coverage, be offered government subsidized coverage, or be left uninsured.

Obama sees the main problem as containing costs. He believes that if health insurance were made more affordable, universal coverage would naturally follow.

Hillary Clinton's Mandatory Coverage
Hillary Clinton is the only candidate who has proposed a mandate requiring that all Americans be covered by some form of health insurance. Under her plan, consumers would choose from a variety of public and private plans, some provided by employers and some purchased by individuals — some of the choices being the same plans currently available to members of Congress. Small businesses would be encouraged, but not required, to provide health coverage to employees. The government would give tax credits to consumers and employers who are paying for health insurance for themselves or their employees; and private insurance companies would be forbidden by law to refuse any paying customer because of a preexisting condition or other form of "discrimination."

"It's time to provide quality affordable health care for every American," Clinton has said. "And I intend to be the president who accomplishes that goal finally for our country."

Barack Obama: Aim for Universal Coverage
Barack Obama also seeks universal coverage, but while the Clinton plan requires universal health insurance, Obama's "aims" for universal coverage.

Obama sees the main problem as containing costs. He believes that if health insurance were made more affordable, universal coverage would naturally follow. He has characterized the Clinton plan requiring that all uncovered adults purchase insurance as "punishing" the poor.

Otherwise, the plans are quite similar, both claiming to offer regular folks the deluxe plans currently enjoyed by Senators and Congressmen, and both promising to forbid denial of coverage for a preexisting condition and to require "portability" — meaning that a person could keep their coverage if they lost their job or changed jobs. Both Democrats say that rolling back some of the Bush tax cuts will pay for the inevitable cost increases associated with any large-scale restructuring of the health care system.

John McCain: Prevention and Personal Responsibility
John McCain's health care reform plan comes from a place considerably to the right of his Democratic counterparts. His is a "free-market, consumer-based system." McCain promises affordable, but not universal health care for all Americans. He believes that free-market competition will drive down the cost of health insurance and make health care more efficient. Proving that he is serious about this, McCain's plan eliminates the longstanding government subsidy of employer-sponsored health insurance by taxing employees for the value of their health insurance — by, in effect, treating the money that is used to pay for health care as income. He claims that cost savings achieved by his plan will more than offset any increases; he promises to maintain the Bush tax cuts.

While McCain stresses personal responsibility — "we must do more to take care of ourselves to prevent chronic diseases when possible, and do more to adhere to treatment after we are diagnosed with an illness," it is not clear how he plans to motivate people to do so.

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