[Rhodes22-list] POLITICAL:Health Care Plans. NYTimes Endorses Obama's

[Ben Cittadino]

Reading this editorial is worth the effort if you have any interest at all in
the McCain/Obama health care debate. I've printed it out so it's easy to
read. You don't even have to click on a link. Just keep reading:
NEW YORK TIMES
 October 28, 2008
Editorial
The Candidates’ Health Plans 
The nation’s health care system is desperately in need of reform — as far
too many Americans know from grim, personal experience. In this election,
Barack Obama and John McCain are offering starkly different ideas for how to
fix that system. 

There is no shortage of problems:

¶ Some 45 million Americans lack health insurance, limiting their ability to
get timely care. 

¶ The costs of medical care and health insurance are rising much faster than
household incomes, making it increasingly difficult for people to afford
either. 

¶ People can’t carry their insurance from one job to another, limiting their
mobility. Outside the workplace, it is hard to find affordable insurance. 

¶ Despite the wealth and technological prowess of this country, the quality
of medical care often lags behind that available in other industrialized
nations. 

Both candidates have largely accepted the prevailing expert wisdom on ways
to improve quality and lower health care costs over the long run, such as
relying more on electronic medical records and better management of the
chronically ill. But they have very different ideas on the best way to make
insurance available and affordable for all Americans. 

We believe that Mr. McCain’s plan, which relies on reshaping the tax code,
is far too risky. It is likely to erode employer-provided group health
insurance and push more people into purchasing their own insurance on the
dysfunctional open market, where insurers often reject applicants with
pre-existing conditions. 

Mr. Obama has focused primarily on extending coverage to a big chunk of the
45 million uninsured Americans by expanding existing private and public
programs with the help of federal subsidies and mandates. His boldest
innovation would be a new federally regulated exchange where Americans not
covered at work would be able to choose — as federal employees currently can
— among a variety of private group policies. He would also create a new
public program to compete with the private insurers. 

Mr. Obama’s plan is a better start than Mr. McCain’s. But it is still not
likely to help all Americans who need and deserve affordable, high-quality
medical care.

As voters weigh their choice for next Tuesday’s election, we offer this
detailed review of the two candidates’ plans. 

THE MCCAIN PROPOSAL Mr. McCain’s main idea is to change the tax code so that
workers would have to pay income taxes on the value of their employer’s
contribution to their health insurance. In return, all Americans, whether
currently insured or not, would receive a tax credit of $2,500 for an
individual or $5,000 for a family to buy health insurance, either through
their employer or on the open market. 

Mr. Obama has derided this plan as giving tax credits with one hand and
taking them away with the other. But the tax credits are initially so
generous that a great majority of workers would end up ahead: their tax
credit would exceed the tax they would have to pay on their
employer-provided insurance. 

They could stay in the same health plan at work and have extra money that
could be applied to other health care costs. Or they could buy policies in
the open market. As good as that sounds, a $5,000 credit would not go very
far toward buying a typical $12,000 family policy but might well suffice for
the young and healthy, who get preferable rates. 

Mr. McCain correctly recognizes that there are disadvantages to linking
insurance to jobs — as thousands of laid-off American workers already are
discovering — and that there is an intrinsic inequity in the current tax
code that favors those who have employer plans over those buying individual
coverage.

The great danger is that Mr. McCain’s plan will fragment the sharing of
risks and costs — the bedrock of any good insurance plan — by enticing
young, healthy workers to bail out of their employers’ group policies to
seek cheaper insurance on their own. Their older or less healthy colleagues
would be left behind, which would drive up premiums at work. The rising
costs could lead many companies to drop their health coverage entirely.

The proposal also offers little protection for older and sicker people
forced to buy policies in the open market. Mr. McCain says the federal
government would help underwrite high-risk pools like those operated by many
states to cover such patients. But the subsidies his aides have talked about
— some $7 billion to $10 billion a year — would fall far short of the amount
needed. 

Mr. McCain would loosen state regulations on insurers by allowing companies
to sell across state lines. Some states require insurers to accept all
applicants and provide specified standard benefits, and they limit the
ability of companies to base premiums on health status. In the name of
promoting competition, Mr. McCain’s plan would free companies from those
terms. Anyone who lost insurance as a result would have to seek coverage
through the high-risk pools. 

THE OBAMA PLAN Mr. Obama would do far more than his opponent to address the
nation’s shameful failure to provide health coverage for all citizens. He
would require all parents to get coverage for their children and expand
Medicaid and the State Children’s Health Insurance Program. He would also
require large and midsize companies to offer health insurance to their
workers or pay into a kitty to subsidize coverage elsewhere — a provision
that Senator McCain castigates as a “fine” but that really is their fair
share of the burden.

Mr. Obama says the government would provide subsidies to encourage small
employers to offer coverage and to help low-income people buy insurance.
This is not a government-run program — as Mr. McCain claims — but it does
give the government a much bigger role than it now has by expanding public
programs and creating a new national plan.

Mr. Obama would also greatly increase government regulation of the insurance
industry. He would require insurance companies to take every applicant and
meet a minimum standard of benefits, and he would prevent them from charging
higher premiums based on an applicant’s health. Some states have similar
requirements now and insurance companies still sell policies there.

COVERAGE Some experts estimate that the McCain plan would reduce the number
of uninsured only modestly because millions of people would drop or lose
employer coverage, and not many more than that would buy policies outside of
work. The nonpartisan Tax Policy Center estimates that the McCain plan would
lower the number of uninsured by a mere two million in 2018, out of a
projected 67 million uninsured in that year. The Obama plan would cut the
number by 34 million, the center says, but still leave nearly 33 million
uninsured. 

The McCain campaign makes an optimistic prediction that up to 30 million of
the uninsured might take out policies using their tax credits. If so, those
policies would probably be meager — with high deductibles, large co-payments
and limited benefits — and unlikely to provide much help in a crisis. 

COSTS Despite all the Republican warnings about high-spending Democrats,
McCain’s plan could be a lot more expensive than Mr. Obama’s, at least in
the early years, and possibly in the long term. This is because the generous
tax credits would drain federal revenues faster than the tax on employer
policies would replenish them. 

The Tax Policy Center estimates that the McCain plan would cost the federal
government $1.3 trillion over 10 years, and the Obama plan $1.6 trillion.
Using different assumptions, the Lewin Group, a consulting firm, estimates
that the McCain plan would increase federal spending by $2.05 trillion over
10 years, compared with $1.17 trillion for the Obama package. 

Neither candidate has persuasively explained how he would pay for his plan.
Mr. Obama says he would apply the money saved by rescinding Bush-era tax
cuts for the wealthy and hoped-for savings from reforming the health care
system, but there is considerable doubt those savings will materialize
quickly. 

Mr. McCain also counts on cost-containment measures but is mostly relying on
market forces to reduce the cost of health insurance and health care. He
expects that people who buy their own coverage will shop for cheaper
policies and make more careful choices about what medical care they really
need. Among the dangers is that chronically ill people may forgo needed
treatments.

Mr. Obama’s plan is the better one because it would cover far more of the
uninsured, spread risks and costs more equitably and result in more
comprehensive coverage for most Americans. We fear Mr. McCain’s plan would
jeopardize employer-based coverage without providing an adequate substitute.
At a time when so many employers are reducing or dropping coverage, that is
not a risk that the country can afford to take."
 
Copyright 2008 The New York Times Company 

This editorial adds to the chorus of knowledgable commentators who believe
the Obama plan for health care makes mor sense than McCains approach.

Ben Cittadino 

  
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