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Election '08: The Health Care Debate

Posted Sep 14 2008 1:32pm

We’re in an economy where the Dow, NASDAQ and S&P500 are spiraling downward, and unemployment, foreclosures and the price of oil are soaring. More than 48 million Americans are without health insurance. Hospitals are seeing record levels of uncompensated care and bad debt. Health insurer competitive rivalry is compressing margins and health plans are reporting very little membership growth. There’s no doubt that health care is a leading domestic policy issue for the upcoming presidential campaign.

In an already politically divisive landscape, get ready for a sharp debate over the next five months. In order to set the stage, following is a high-level recap of the candidates’ health care positions to date –


Barack Obama, a Democrat, has served as a Senator from Illinois since 2004. He served in the Illinois State Senate from 1997 to 2004.
Obama says:

“We now face an opportunity – and an obligation – to turn the page on the failed politics of yesterday’s health care debates.... My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”

Obama’s plan has the following features:

Guaranteed EligibilityNo American will be turned away from any insurance plan because of illness or pre-existing conditions.

Comprehensive BenefitsThe benefit package will be similar to that offered through Federal

Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care under a plan with affordable premiums, co-pays and deductibles.

National Health Insurance ExchangeProvide help to individuals who wish to purchase a private insurance plan by establishing an Exchange to act as a watchdog group. This Exchange will facilitate the reform of the private insurance market by creating rules and standards for participating insurance plans. It will ensure fairness and make individual coverage more accessible.

Employer ContributionEmployers that do not offer insurance, or make a meaningful contribution to the cost of coverage for their employees, will be required to contribute a percentage of payroll toward the costs of the national plan.

SubsidiesIndividuals and families who do not qualify for Medicaid or SCHIP but still need

financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.

Mandatory Coverage of ChildrenRequire all children have health care coverage. The goal is to expand the number of options for young adults to get coverage; including allowing young people up to age 25 to continue coverage through their parents’ plans.


John McCain, a Republican, has served as a Senator from Arizona since 1986. Previously he served as the Representative from Arizona's 1st Congressional District. McCain Says:

“The key to health care reform is to restore control to the patients themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care.”

McCain’s plan has the following features:

Make it easier for individuals and families to obtain insurance.An important part of a plan is to use competition to improve the quality of private health insurance with greater variety to match people's needs, lower prices, and portability.

Change the tax code.While still having the option of employer-based coverage, every family will receive a direct refundable tax credit - effectively cash - of $2,500 for individuals and $5,000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider.

Making insurance more portable.Give Americans insurance that follows them from job to job. Provide insurance that is still there if they retire early and does not change if they take a few years off to raise the kids.

Expand Health Savings Accounts (HSAs).When families are informed about medical choices, they are more capable of making their own decisions and often decide against unnecessary options. Health Savings Accounts take an important step in the direction of putting families in charge of what they pay for.

Care for the traditionally uninsurable.Make coverage accessible for those without prior group coverage and those with pre-existing conditions who have the most difficulty on the individual market.

Establish guaranteed state run access plans.Develop a state-run model - Guaranteed Access Plan or GAP - to ensure high risk patients have access to health coverage. One approach would establish a nonprofit corporation to contract with insurers to cover patients who have been denied insurance.

To drill-down into the details of each candidate’s health care position, the following Kaiser Family Foundation website provides a side-by-side comparison of each candidate’s health care platform –

Stay tuned. There will be flip flops, promises and finger-pointing as the candidates jawbone over one of the most pressing issues facing Americans – our health

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