Obama, McCain Shift The Health Care Debate

National Review Online: Both Candidates Recognize That Key Question Is Not Coverage, But Cost

(National Review Online)  This column was written by Michael Tanner.

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For some time now, the debate over how best to reform the American health-care system has been dominated by the question of “universal coverage,” how to provide health insurance to those without it. That remains the battle cry of Sen. Hillary Clinton, who promises to provide “health insurance for every single American.”

However, if John McCain and Barack Obama become the candidates for president this fall, we may see a subtle but useful shift that could actually lead to improving how health care is provided in this country. Both McCain and Obama recognize that the key question in health-care reform is not coverage, but cost.

Clinton and Obama have clashed over the question of an individual mandate (requiring every American to purchase insurance). Hillary supports such a mandate, claiming that it’s the only way to ensure universal coverage. Obama opposes one, arguing that “the reason people don’t have health insurance is not because they don’t want it, it’s because they can’t afford it.” Instead of a mandate, therefore, Obama would focus on a combination of cost cutting and subsidies to reduce the price of insurance. While he believes that his proposal would greatly increase the number of Americans with insurance, he admits it will fall short of 100-percent coverage.

John McCain also steers clear of attempts at universal coverage. “Bringing costs under control is the only way to stop the erosion of affordable health insurance,” McCain says on his website. A McCain spokesman adds, “You worry about the uninsured, but they are a symptom of a larger problem. Unless you do something about cost, you are chasing your proverbial tail.”

Obama and McCain are reflecting a growing consensus among health-care experts that the continued growth of health-care spending is unsustainable and that something must be done to bring costs under control. The United States spends roughly 17 percent of its Gross Domestic Product on health care, far more than any other country, and that is projected to rise to 20 percent of GDP by 2015. While that spending has undoubtedly helped buy the highest quality health care in the world, the distribution of costs has clearly made care unaffordable for many businesses and individuals. Nor should we forget that the skyrocketing cost of government health-care programs like Medicare and Medicaid is threatening to bury our children under a mountain of debt and taxes.

That is not to say that Obama and McCain agree on how to reduce health-care costs. Obama would rely much more on the heavy hand of government. Among other things, he would impose caps on insurance premiums and price controls on drug companies. He would have the government establish national practice standards for doctors. And, he would create a National Health Insurance Exchange as a sort of clearinghouse to make it easier for businesses and individuals to shop for the best insurance.

McCain, in contrast, would attempt to promote greater competition among private health insurers. He would allow people to buy insurance plans across state lines, which will help drive down rates. And he would try to shift away from our current employment-based insurance system toward a system where individuals purchase and own their own insurance plans. He would do this by replacing the current tax break for employer-provided insurance with a refundable $2,500 tax credit for individuals, and $5,000 for families. The idea is that once people start to buy their own insurance, they’ll be in a position to insist on lower prices and higher quality - just as they do with every other product they buy.

Both Obama and McCain would take other steps as well, including encouraging greater use of generic drugs, promoting the use of electronic medical records, emphasizing prevention, and providing incentives for more integrated medicine - treating illnesses rather than symptoms. Studies suggest, however, that savings from these proposals may be less than either candidate has hoped.

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Candidates' Health Care Proposals
WebMD Details The Health Care Proposals Of The Presidential Candidates

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Overall, McCain has the better proposal. Obama’s plan, with its heavy reliance on government, leads to the same problems that bedevil universal healthcare systems all over the world: limited patient choices and rationed care. McCain’s proposal is much more consumer centered and taps into the best aspects of the free market.

But regardless of who becomes president, we can expect major changes for the American health-care system. And it’s a good sign that we’re beginning to debate the right things.

[cyberus-2009]

The problems with a tax credit for insurance seems to escape McCain (and the author of the article) ...

... You have to be able to afford to buy insurance in the *first* place to get the credit.

... Even if one were allowed to take the credit as an exemption during the year (using the cost of insurance as a payroll tax deduction) you have to make enough money to pay $2500 in excess taxes.

... a quick perusal of health insurance quotes shows that the $208 per month of the credit isn''t enough to pay for a health plan with deductibles low enough to be usable by the people that are most likely to BE uninsured in the first place.

Point is while McCain has better ideas than many Republicans, he is still (IMO) too disconnected from the class of people that are uninsured to really grasp the issue. A $2500 deduction for insurance simply gives people a tax break on insurance that already CAN afford.

[noloyalisti]

All we need is government-run single payer health care. Cut out the by-nature cheating profit above all insurance companies.

We already have working socialized programs in Medicare and VA medical. Time for the government to start working for ALL the people.

[heartlight3]

I keep hearing Republicans say that competition reduces costs. That is one of those statements that sounds reasonable, but when you examine the evidence, it doesn''t work. Has your cable bill gone down because of competition? How about your car insurance? Gasoline? Anything? How long will it take for us to see that that is a fallacy?

[bombadil4]

Another way to help ourselves (beyond prevention) is to expect less from the medical/drug cartel. Expect that almost always your discomfort or pain is being caused by one of the 90 perecent of all known conditions that are self-limiting. You''ll get better with or without medical intervention. Right now it''s totally a seller''s market and we have been more or less brainwashed into expecting to be tested, treated, and drugged to the max. Much of that is a scam and always has been. The body goes out of balance ocassionally and some discomfort is no more than a normal fact of life. Buck up, mate.

[samthetvcat]

"The idea is that once people start to buy their own insurance, they%u2019ll be in a position to insist on lower prices and higher quality - just as they do with every other product they buy."

rotflmao - that''s not the idea. The RepubliCON idea is to make it so corporations no longer have to provide healthcare for their workers. McCain''s idea would supposedly result in something like 170million workers losing their insurance coverage through work.

If the Republidorks could actually think something through for once, they''d realize that the cost to let corporations off the hook is actually like $300billion a year (tax revenues for only 75million workers, at around $4k, tax credits to 225million, at around $3k . . . )

Hence, the Democratic plan is actually like 3 to 4 times cheaper than the Republican plan and DOES in fact lower costs by taking on big pharma and big insurance . . .

[noloyalisti]

When are we all going to admit that this privatization scheme is a complete failure? It has never worked but keeps the rich getting richer. If we don''t get the current GOP Milton Friedman freaks out of government, we are in real trouble.

Our current economic policies are like Reagan''s failed policies on steroids.

[magnetrack]

Read Paul Krugman''s book. Any of the major European systems, all rated considerably better than ours, could be dropped into the United States at lower than present cost. Senator Clinton is the only candidate that really knows health-care.

[random_radar]

Eliminate medicare and you will save a whole bunch of money--both on health care and social security benefits that no longer have to be paid to deceased non-productive people.

No one has the right to make someone else pay for their health care, food and shelter, or anything else. Work or die.

[DrColes]

The government caused the entire problem with health care in America by over socializing (with unfunded mandates) medicine to the extent it is not completive. The government allows a monopolistic pharmaceutical environment, and the FDA a federal agency failing American citizens and needs be eliminated or completely re-organized; it%u2019s corrupt, and is causing a major impact on the cost of healthcare in America, and we want to exacerbate the problem? http://www.InteliOrg.com/

[jsaarikko]

All proposals by Clinton, Obama and McCain are seriously flawed. Way too much to explain here. Go to my web site and allow a lot of time to read it. The numbers are there. CBS should publish it.
http://universalhealthcareinfousa.com

[rudy654-2009]

Cost? Duh! But where do they think they can get it down to? As someone already said, Western Europe outrates the US in health care. The people there aren''t coming here to get it. At the present, they live longer than we do. I don''t support Clinton, but Obama is completely blank on the subject:

"Obama would focus on a combination of cost cutting and subsidies to reduce the price of insurance."

And the heavens will open up and everything will be so beautful. Right, Obama.

[magoo2u1]

"No one has the right to make someone else pay for their health care, food and shelter, or anything else. Work or die"
You clearly do not understand how insurance works. Next time you have an accident in you vehicle, your fault or not, fix it yourself and don''t ask the rest of us to help. The gov uses my tax money to fund research in univerities around the country but you would deny me any benefit from that resaerch. Up yours. I pay for roads I don''t drive on and air traffic control system I rarely use. A judicial system I have never been caught up in etc......

[magoo2u1]

I think it was John Smith that declared "if you don''t work, you don''t eat" in the Jamestown settlement. He was talking to the rich investors that came on the boat and thought they could benefit from the hard work of farmers and blacksmiths while they waited for their investment to pay off, not the "little guy".
The rich fat as sses sat on their duffs expecting to keep their hands clean and still eat. The republicans have inverted the original complaint to use it against the weak and infirm to deny them basic humanity. LOOK UP YOUR HISTORY.

[mcvet]

And the heavens will open up and everything will be so beautful. Right, Obama.


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Posted by rudy654 at 12:43 AM : Mar 13, 2008
+ report abuse

So you suggest we just stay with McSAME?? ROFLMAO We already know where that boat takes us... we had 6 LONG years of Fascist rule and NOT ONE thing was done about Health Care, nothing, NaDa, ZERO. So any movement, since we have the worst already, is an improvement. Sieg Heil Bush!!

[juwboy]

heartlight3:

Competition certainly doesn''t reduce costs in the health care field.

When MRI became a major diagnostic technique, a number of years ago, some of my local hospitals each purchased one of these multi-million dollar machines.

Because of the COMPETITION for patients, all of the other local hospitals had to purchase them, too, creating a SURPLUS capacity for MRI testing.

As a result, in order to recover the cost of these outrageously expensive machines, MRI tests were soon being ordered in situations where much cheaper, and perfectly adequate, alternative tests would have done the job.

Competition, in this case, increased health care costs outrageously.

[mcvet]

Eliminate medicare and you will save a whole bunch of money--both on health care and social security benefits that no longer have to be paid to deceased non-productive people.

No one has the right to make someone else pay for their health care, food and shelter, or anything else. Work or die.


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Posted by random_radar at 05:15 PM : Mar 12, 2008
+ report abuse

It''s disgusting that the results of the Greatest Generation is people like this. You sound like a member of the Third Reich! Work them to death and when they can''t work anymore, put them in mass graves huh? I certainly hope YOU get sick sparky, very sick. I certainly hope that one of these PROFIT motivated Insurance Company''s just drops you on your behind without any coverage. Then see how YOU feel about your attitude! God I hate Nazi''s!! Sieg Heil Bush

[mcvet]

All proposals by Clinton, Obama and McCain are seriously flawed. Way too much to explain here. Go to my web site and allow a lot of time to read it. The numbers are there. CBS should publish it.
http://universalhealthcareinfousa.c
om


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Posted by jsaarikko at 08:38 PM : Mar 12, 2008
+ report abuse

You maybe right but the FACT is that NO Republican is going to fix or even slow down the fall of our health care system. THAT''s something we ALREADY know. Sieg Heil Bush

[mcvet]

The government caused the entire problem with health care in America by over socializing (with unfunded mandates) medicine to the extent it is not completive. The government allows a monopolistic pharmaceutical environment, and the FDA a federal agency failing American citizens and needs be eliminated or completely re-organized; it%u2019s corrupt, and is causing a major impact on the cost of healthcare in America, and we want to exacerbate the problem? http://www.InteliOrg.com/


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Posted by drcoles at 06:06 PM : Mar 12, 2008
+ report abuse

ROFLMAO Now ALL the Health Care Systems in the world that are AHEAD of us, better than we are, ALL of them have far more mandates and oversite than our system does. Sorry no Magic Swastika for that try!! Sieg Heil Bush

[forthepeopl1]

McCAIN SELLING OUT AMERICAN JOBS JUST LIKE HIS BOSS BUSH..............................

AP) Top current advisers to Sen. John McCain''s presidential campaign last year lobbied for a European plane maker that beat Boeing to a $35 billion Air Force tanker contract, taking sides in a bidding fight that McCain has tried to referee for more than five years.

Two of the advisers gave up their lobbying work when they joined McCain''s campaign. A third, former Texas Rep. Tom Loeffler, lobbied for the European Aeronautic Defence and Space Co. while serving as McCain''s national finance chairman.

EADS is the parent company of Airbus, which teamed up with U.S.-based Northrop Grumman Corp. to win the lucrative aerial refueling contract on Feb. 29. Boeing Co. Chairman and CEO Jim McNerney said in a statement Monday that the Chicago-based aerospace company %u201Cfound serious flaws in the process that we believe warrant appeal.%u201D

McCain, the Republican presidential nominee in waiting, has been a key figure in the Pentagon''s yearslong attempt to complete a deal on the tanker. McCain helped block an earlier tanker contract with Boeing and prodded the Pentagon in 2006 to develop bidding procedures that did not exclude Airbus.

[magnetrack]

Obama''s opinions matter less by the minute...

[eskieville1]

Capitalism and health care is a bad combination. Neither Mccain or Obama will get us the reform we need. I prefer a single payer universal system. I would accept Medicare for all and forcing the insurance companies ( regulated by the gov.) to compete to sell us the supplemental policies.

[myshiba]

It''s both coverage AND cost! Please get a clue!

[random_radar]

Why do people think the government will provide better health care at lower cost? The government never does anything better at a lower cost. It just forces you to pay for the lousy job it does.

[arlt1627]

randon_radar wrote:
No one has the right to make someone else pay for their health care, food and shelter, or anything else. Work or die.


You''re the type of person that is ruining America. Selfish, arrogant and ignorant....."I should ONLY pay for what I use...screw everyone else..." That attitude will doom us in the future. Imagine if FDR took on that attitude during the Depression. I can hear it now..."it''s all your fault you didn''t know that banks were going to fail, you didn''t have good enough jobs, and so on." The only way to fix our country is to work together and quite being so selfish. Everyone needs police, fire, roads, bridges, insurance opportunities, plows, etc.

[brianbwb-2009]

"The idea is that once people start to buy their own insurance, they%u2019ll be in a position to insist on lower prices and higher quality - just as they do with every other product they buy."

This idiot must never have tried to buy groceries. Try to bargain the price, or try to bargain with Wal Mart, or even McDonalds, no luck, Chuck, and you haven''t seen such since the 1950s.

Insurers nationwide will simply collude to hold the prices high, as they do now. This writer is apparently unaware of how today''s market works, either that or the writer thinks that readers will accept this Pollyanna-ish delusion of fair and honest business.

[brianbwb-2009]

"Why do people think the government will provide better health care at lower cost?" Posted by random_radar

Because they cannot do worse than the corrupt private sector, and if they do, at least we can hold them personally responsible with their jobs, because we can control the money trail.

[confused101a]

Posted by brianbwb at 04:33 AM : Mar 14, 2008
Because they cannot do worse than the corrupt private sector, and if they do, at least we can hold them personally responsible with their jobs, because we can control the money trail.
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Posted by random_radar at 01:52 PM : Mar 13, 2008
Why do people think the government will provide better health care at lower cost? The government never does anything better at a lower cost. It just forces you to pay for the lousy job it does.
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ainttaken & brianbwb you are both wrong. random_radar understands that you can not control Congress, and they can''t control anything.

[clifden6]

This is one example where a government, the French government is outperforming the US private sector.
HEALTH CARE UNDER FRENCH NATIONAL HEALTH INSURANCE
The United States has traditionally looked to the United Kingdom, its cultural parent, when studying alternative social and political models. Health care is no exception.The French health system is a model no less worthy of study than the British, Canadian, or German systems. Fee-for-service reimbursement, total freedom of provider choice, an important private forprofit hospital sector, and patient copayments exemplify a principle of "liberalism" that some Americans find missing in the British and Canadian systems.However, a principle of "solidarity" nourishes a national health insurance system that provides nearly universal coverage, and stringent government price controls keep price levels well below those of the United States.There are four major differences between the two systems (US vs. France): the French system covers more than 99 percent of the population; the prices of health services in France are lower than in the United States; the volume of most services is higher than in the United States; and French health care spending per capita is lower than in the United States.

[clifden6]

Senator Obama''s approach may appear heavy handed in dealing with the US private sector health care system, but how else to deal with a greedy, maximum profit, minimum medical care private sector approach. They need shock treatment like Senator Obama''s approach,basically give them a deal they can''t refuse.

Obama would rely much more on the heavy hand of government. Among other things, he would impose caps on insurance premiums and price controls on drug companies. He would have the government establish national practice standards for doctors. And, he would create a National Health Insurance Exchange as a sort of clearinghouse to make it easier for businesses and individuals to shop for the best insurance.

[usa_911]

Thank you for another corporate biased article, designed to guide people to McCain in November. It is all encapsulated in the second to last paragraph, where Obama''s plan relies "heavily on government" (which we have all been convinced by the media is a bad idea), and leads to "problems" just like those bad national health care systems in Europe and Canada.
And then finally the "limited choices" and "rationed care" fraud. We have both limited choices and rationed care now with our corrupt insurance system. Only now over 47 million citizens of our "democratic" nation are rationed out of the system entirely.
And the band plays on...

[Marie Zarankevich]

The health care and housing markets are showing us that our "Thing" is about to fall apart. Simple greed has taken us to our knees. The rich get richer, and the poor now just die in the emergency room, waiting for an intake nurse. Will we understand the dynamics when nobody can afford a place to live who doesn''t already own their own island? What planet are they planning to take all their wealth to, when this one dies? Shame on everybody.

[liny516]

First, thank you CBS for sticking to the issues that America really cares about in this campaign. Continue to put out these type stories.

Second, the two candidates have different positions that americans should examine and determine what best fits their lifestyle. This is what they should base their votes on, not race, ***, or religion.

[rowdytexan2]

First of all, it is really humorous that they''re presenting this like it''s going to be a battle only between Obama and McCain since Mr. Obama is not the candidate yet.

The second irony of this article is that in the first debate, Hillary Clinton was the one who addressed the cost of health care and stated that the cost should be regulated so people could afford it.

McCain and Obama are in fact several months behind Hillary on this issue.

[rowdytexan2]

A universal health care plan is going to have to be mandated one way or another. And EVERYBODY is going to have to share in the cost of it, just as everybody has to share in the cost of the auto insurance mandate.

The ticker on this one is implementing regulation of the insurance industry''s profiteering off the suffering of American citizens and bringing health care to costs and salaries. That''s why they need to just get insurance companies out of the picture and develop a national health trust. But of course when that was tried in the 90''s the republicans blocked all avenues of funding it, and cried socialism, socialism! And the gullible public bought it.

[willbarefoot]

If either plan is going to work they are going to have to address the following issues.
1) People with existing health problems have difficulty buying insurance at any price.
2) As people age the premiums become too expensive to afford.
3) Government mandates such as putting mental health coverage on an equal footing with other health care benefits increases the cost for everyone.
4) The health care industry competes for patients on the basis of comfort and convenience which often raises the price.