Opinion: Obama vs McCain on the health-care crisis

October 1, 2008

McCain's plan is market driven and would employ refundable tax credits while Obama would build on the current employer-based insurance model. Both plans are flawed.

John McCain, while no scholar (he graduated near the bottom of his class at Annapolis), displayed unparalleled courage, selflessness, physical toughness, mental discipline, and patriotism as a prisoner of war in Vietnam. After retiring from the Navy as a captain in 1981, he moved to Arizona and was elected to the US House of Representatives in 1982 and the US Senate in 1986. Early in his legislative career he was implicated in the "Keating five" scandal and resolved to become the Senate's most ardent opponent of lobbyist influence, pork barrel spending, and special interests. At substantial political risk, he supported the Iraq troop surge, which appears to have brought relative stability to that unfortunate country. While Obama would be one of our youngest Presidents, McCain would be our oldest first-term president.

Party platforms

On social issues, the Republican platform opposes gun control and reproductive freedom, while the Democrats would limit assault weapons but not abortion. The Republicans favor across-the-board tax cuts but propose no corresponding entitlement reductions to balance the budget, an approach that would exacerbate our budget deficit. They also favor unrestrained free trade and would continue the ineffectual efforts of the Bush administration to reduce our burgeoning trade imbalance and outsourcing of domestic jobs. In contrast, Democrats would raise personal income tax on upper income individuals, raise corporate taxes, and impose tariffs, steps all likely to exacerbate the current recession.

Health-care reform

As ob/gyns, we should be particularly interested in the two parties' proposals for health-care reform. Here again, the contrasts between the two tickets are dramatic. The basic elements of their respective plans are as follows:

Mc Cain's plan is market driven. It would replace the current tax-free status of employee health insurance coverage with refundable tax credits, worth $2,500 for individuals and $5,000 for families.1 Those with current employee coverage could use the credits to offset the tax increase they would otherwise experience, while those without current employer coverage would also receive these tax credits, which could be used to purchase insurance in the market. To insure the latter had access to affordable insurance, McCain would deregulate the insurance market so that individuals could purchase the cheapest plan offered anywhere in the US and not just in their state. To further reduce costs, he would transition Medicare payments from the traditional fee-for-service methodology toward payments for bundled episodes of care modified for the quality of care and outcomes. He anticipates commercial plans would quickly adopt similar strategies. He posits that additional cost savings would accrue from an increased emphasis on high-deductable consumer-driven policies, simplified insurance claim forms, an increased emphasis on preventative care, improved management of chronic diseases, tort reform, faster introduction of generic drugs, and dissemination of electronic medical records.