Wonky Health Care Post

The McCain campaign web site contains more on border security than health care. McCain's "vision for health care reform" is only worthy of a single paragraph.

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.

The McCain web site doesn't include health care in the drop menu of issues. The actual health care page does has not have a plan. Visitors are greeted with a short McCain video talking about giving tax credits. Those tax credits don't help people below the poverty line (who pay no taxes) or sick people that can't find a health care provider. The great irony is McCain has been on public health care his adult life; as a Navy veteran and as a member of Congress.

The Des Moines Register editorial board questioned McCain about having public health care.

"You know that's an interesting statement, isn't it? And I have never been an astronaut, but I think I know the challenges of space. And I have never done a lot of things in my life that I think I am familiar with. I've always been a free enterprise person who thinks that families make the best decisions for themselves and their future...so the answer is that most of my life, in serving my country I have had health care. I did go a period of time where the health care wasn't very good."

McCain can't be unsatisfied with public health care since he is still a recipient. The Maverick feels what works for him doesn't work for the American people. The Chutzpah of McCain's position is staggering.

The free market Maverick wants to end the tax breaks for employers offering health care.

The crux of McCain's healthcare plan is to end a tax break for employers who provide health insurance premiums now utilized by many workers. That would be replaced with a tax credit worth as much as $5,000 per family for the purchase of health insurance. McCain would also promote cost controls and competition among insurance companies. He has also joined with Democrats to support legislation that would allow the purchase of prescription drugs from Canada.

Employers would have less incentive to offer health care. Workers would have to get health care from the market and hope a provider will give them coverage. Many employees will be left without health care. These so-called free market principles are actually a way for health care companies to shed coverage and raise prices. Columbia University Health Policy and Management Sherry A. Glied why this is a explains why this is a horrible idea.

The reality is that providing coverage through nongroup plans is much more costly than providing that coverage through groups. Administrative expenses are twice as high in nongroup markets as in group markets. The costs are higher because insurers in this market spend considerable resources on medical underwriting, and economies of scale are lost. It is much more expensive to sell insurance to millions of individuals one individual at a time than it is to sell to a much smaller number of employer groups, each comprising thousands of employees. For a typical family that moves from group to individual coverage, therefore, the move to nongroup insurance will raise premiums for an identical policy by more than $2,000 per year. Shifting people into the nongroup market would not save money for most Americans. Rather, it would lead to increased spending on administrative costs and a decrease in the portion of health spending that actually goes to providing care.

McCain's plan gives a health care tax credit the rich and lacks details on how health care costs can be brought down. A person only receives the tax credit if he or she purchases health care. That doesn't help people that can't afford health care. Harvard health policy and economics Professor Mary Carmichael did an estimate of McCain's health care proposal.

My colleagues and I have predicted that around 21 million people in the first year would lose access to health insurance because their employers would stop offering it. About 21 million higher-income people would take the tax credits and buy their own insurance. So it would be a wash in the first year. We worry that within five years, more employers would stop offering insurance, and we'd end up with more people uninsured than there are now.

The John Edwards plans offered the most wonkish solution to dealing with health care costs. The Edwards solution is shared financial resonsibility between the public and private sectors, tax credits and regulation on health care premiums. Another good plan came from John Kerry's 2004 campaign. Kerry focused on lower the cost for people with health insurance premiums paid by employers and employees.

Kerry's catastrophic-illness relief plan is the only new health care proposal -- and the most expensive -- of this campaign season. It marks the first time in 12 years that a political leader has attempted to reorient the insurance market away from dodging the costliest patients and in the direction of implementing higher quality of care.

The concept of a national reinsurance pool has garnered support from a wide spectrum of players from labor unions and former Vermont governor Howard Dean on the left to former House speaker Newt Gingrich and former Bush economic adviser R. Glenn Hubbard on the right.

I have read the Barack Obama plan. I'm unsure how the Obama plan would be paid off. I don't expect the Obama campaign to address that question during an election. Carmichael and and a Health Affairs pound the point that Obama isn't being upfront about the cost. Judging by Obama not fighting offshore drilling and warrantless wiretapping; it is doubtful President Obama would battle Congress for his own health care plan.

Obama's plan is not universal health care and political pandering. McCain's plan is dangerous.