The United States will be unable to fix its health care problems "unless we pull the best strands from Democratic and Republican proposals," a University of Marylandprofessor and health policy expert said yesterday.
"This is not a problem that will cure itself," said Jack Meyer, a professor in the university's school of public health and policy, during his presentation on the health care plans of presidential candidates Sens. John McCain, (R-Ariz.), and Barack Obama, (D-Ill).
There are 45.7 million uninsured people in the United States - including about 8 million children - and 25 million underinsured people who have too little coverage to meet their needs. Meanwhile, health care premiums are growing at least three times faster than wages are.
This means the health care crisis needs to be dealt with on two fronts: covering the uninsured, while also stopping health care costs from spiraling completely out of control.
These problems are also exacerbated by the breakdown in traditional employer-provided health insurance system, as more and more companies - particularly smaller ones - leave employees on their own to find health insurance because the employers are unable to pay costs. The number of employers providing health insurance has been steadily declining by about 1 percent each year, Meyer said, but the pace could accelerate.
"The employer-based system is not imploding, it's eroding," Meyer said.
The proposals from Obama and McCain take two drastically different approaches to the problem.
McCain's health care plan, the centerpiece of which is health care tax credits so people can buy insurance on the private market, relies on the traditionally Republican ideas of individuality and private choice and would do less to cover the uninsured.
Obama's proposals, which include mandatory coverage for children and a national health insurance exchange, involve more government intervention and would be more expensive, Meyer said.
Either way, Meyer said it wouldn't be politically easy to pass either plan. Democrats are likely to be in control of Congress but may not have the 60 votes needed in the Senate to stop a filibuster, meaning votes from both sides of the aisle will be needed, Meyer said.
If no political pain is involved, he said, "you know it's not a serious plan to cover the uninsured."
The aspect of McCain's plan most likely to cause him political pain, Meyer said, is the elimination of the tax exemption for employee benefits. Unlike normal wages, health care benefits do not count towards the income tax.
"It's a big tax break to get your health care from your boss," Meyer said.
After removing the health care tax exemption, McCain would use the extra tax revenue to provide health care tax credits - $2,500 for individuals and $5,000 for families. Taxpayers in good health would use the tax credit to buy health care plans on the individual market or to pay premiums if their employers provide a plan. Taxpayers with health problems who otherwise would be denied care would be put into high-risk pools set up by the government, which would then negotiate a care plan with independent insurance companies.
Obama's plan would require all parents to insure their children and would automatically enroll eligible people in government-sponsored programs unless they asked not to be. It is estimated that 12 million people are eligible for government assistance on health care but do not receive it. It would also let children stay on their parents' health insurance plans until age 25.
It would also create a national health insurance exchange for people without access to health insrance. They would be able to sign up for a plan similar to the one given to members of Congress and given a sliding subsidy based on their income.
Meyer cited an analysis by the Tax Policy Center, a non-partisan think tank in Washington, that said McCain's plan would cost $1.3 trillion over the next ten years and would cover nearly 5 million by 2013 and slightly more than that by 2018, leaving about 64 million people uninsured, Meyer said.
In contrast, the Tax Policy Center analysis has Obama's plan costing $1.6 trillion over the next ten years and insuring an extra 34 million people, while leaving that same number uninsured, in 2018.
Meyer said a 20-year picture of the costs would be more accurate, however, because the costs for McCain's plan decline over time, where Obama's costs rise.
"If you did a 20-year chart, Obama vs. McCain, it would be favorable to McCain," he said.
But he said each plan could benefit from some of the other's ideas - and likely would have to adopt them in order to pass Congress.
Obama's plan, which Meyer said is not fully financed - the Obama campaign says it will be - could borrow the idea of eliminating the tax exemption from McCain. McCain's plan, on the other hand, could add an expansion of SCHIP, a program that gives health insurance to low-income children.
During a question-and-answer session after the presentation, another professor asked Meyer about a claim commonly advanced by Princeton University economist and New York Times columnist Paul Krugman: that single-payer health insurance would save money by eliminating administrative costs.
"There's no question single-payer saves money," Meyer said. "There are some tradeoffs Americans need to think about."
He said Americans are traditionally resistant to large-scale government intervention in the economy and that countries with single-payer systems typically pay doctors less and have less access to advanced medical technologies.