Two candidates, two very different ideas

419-993-2094

LIMA - More than any domestic issue this election, health care has produced major differences from the presidential candidates.

Democrat Barack Obama and Republican John McCain go literally in opposite directions on health care: While Obama would add a major role for the federal government in the system in the name of coverage for everyone, McCain would put even more of the system in the free market in the hopes of lowering overall costs through competition.

Plenty of criticism abounds for both plans, whether it's McCain's plan that does little to address the numbers of the uninsured or Obama's plan with estimates far below what most experts believe will be the cost.

Health care costs have tripled since 1990, going from $714 billion to $2.2 trillion last year, according to federal numbers. About 46 million Americans, a fifth of them children, remain uninsured. Nearly four in 10 Americans reported last spring that difficulty in paying medical bills was leading to other serious financial problems, according to the Kaiser Family Foundation.

Candidates' plans

Both candidates say their plans improve the current system and make health insurance affordable. McCain stresses a "portable" system while Obama an "accessible" one.

Obama wants affordable high-quality coverage for everyone through a mix of private and expanded public insurance. McCain would provide access to affordable care by paying only for quality care, having diverse choices responsive to individual needs and encouraging personal responsibility, according to an analysis done by the Kaiser Family Foundation.

While he gives this part of his proposal no attention on his Web site issue papers, McCain would take away the favorable tax treatment employees receive on their health insurance benefits. McCain would tax the health benefits as wages. He does highlight a refundable tax credit, essentially cash, of $2,500 for individuals and $5,000 for families to help pay for coverage.

McCain would encourage competition in the marketplace by allowing insurance to be sold across state lines. The tax credit would help with the cost of insurance through an employer, but also encourage people to buy coverage on the open market, decreasing cost, McCain believes.

McCain opposes mandates for people to have insurance or employers to provide it. He would create a program for people denied coverage because of pre-existing conditions. Premiums would be limited and assistance given to those below certain income levels.

Obama would require employers to offer insurance or pay a tax contributing to a new federal plan for those without it. He would expand Medicaid and a government insurance plan for children and require all children to have insurance.

Obama would also create what he calls the National Health Insurance Exchange, through which people who didn't like their coverage. Those without insurance or small business owners wanting to provide it to their employees could enroll in a new public plan or approved private plans.

In the public plan or participating private ones, no one would be denied coverage for pre-existing conditions or have to pay a higher premium because of one.

Other initiatives

McCain and Obama actually agree on some other details to lower health care costs. They also have specific initiatives to lower costs and improve quality.

They both support safe importing of drugs from other countries, investing and improving preventative and chronic care and different forms of malpractice reforms.

Both candidates support improving electronic medical records and health information technology. Obama would invest $50 billion there, while McCain believes if consumers demand improvements the market will provide them.

McCain has called for the ability for veterans to use their VA benefits to pay for private care and Obama has said he will strengthen existing centers.

Both candidates support getting generic drugs to the market more quickly. Obama would allow Medicare to negotiate directly with drug companies. McCain supports adding a requirement to Medicare and Medicaid that drug companies compete against each other.

Plan criticisms

Both plans amount to huge change for the American public and face significant challenge from voters, Congress and special interests. Both plans also have also received significant criticism.

While McCain's tax credit would likely offset his taxing of health care benefits, his plan doesn't cover how the plan would keep up with health care costs rising faster than inflation, according to MSNBC.com and the Kaiser Family Foundation. The plan benefits the young and healthy, while others would pay higher premiums.

McCain's plan is likely a wash, according to the Associated Press, with those losing employer-sponsored coverage and those gaining it privately. It also does little to address the issue of those who are not insured.

Obama has said it would cost between $50 million and $65 million to cover the currently uninsured, with much of the cost paid for by raising tax rates on those making more than $250,000. However, most analysts agree the price tag is likely double that.

Also, Obama's plan would require all but small businesses to provide coverage or pay a tax. That kind of mandate could result in job losses or pay cuts, analysts have said.