Note: please see Healthcare.com's HealthDecision 08 for a comprehensive and nonpartisan breakdown of Barack Obama and John McCain's healthcare plans.
The day of reckoning for Barack Obama and John McCain is now just under three weeks away. The campaign has intensified to a level that could hardly have been anticipated last June when Obama secured his victory in the primaries. General interest has peaked, as has voter registration. People throughout the world are obsessing over every development in this campaign, as two inherently likeable, yet unorthodox characters battle it out in order to win the right to lead the world’s most powerful nation, which is itself at such a critical juncture.
The US economy is in a frightful state and worsening as every day draws on, despite massive and unprecedented government intervention. The United States is involved in direct wars on two fronts, and an indirect war on terrorism on countless others. For the first time in decades, Washington faces credible global competition. All the while, dissatisfaction with the state of the country on behalf of ordinary Americans has reached historical proportions. There is no doubt it will take prodigious skill, unequalled intellect, and original vision to lead the US out of this quagmire and renew the country’s great promise. Each presidential candidate can, in their unique ways, make a convincing case to be that person. Both Obama and McCain have profound biographies, far-reaching vision, and unfaltering dedication to their country.
However, they each approach problems from their own divergent philosophies.
There is one subject, which is of immense importance that illustrates their disparate beliefs. Healthcare, as the election approaches, is foremost on the minds of many Americans. There is no wonder why. Prescription drug costs are high. Medical costs are sky-rocketing. Many Americans receive their health insurance through their employers which bears some notable negatives. As the National Review points out, rising premiums have a harmful impact on take-home pay. Employees are often deprived of agency in deciding their healthcare package as the choice is made by employers. And very often, termination of employment will leave someone, not just unemployed but, lacking medical coverage. Most staggering of all, approximately 47 million people in the United States live an uncertain life without health insurance.
With such a stark reality in mind one would think that the issue of healthcare has been the preponderant focus of the presidential campaign. It has not. It’s easy for everyday realities to be overshadowed by fundamental changes such as Russia’s invasion of Georgia or the current financial crisis. However, less excusable is the ease with which the candidates have allowed this campaign to be distracted by debate on peripheral or trivial issues of fleeting importance. For quite some time, there was far more discussion of gaffes, East Coast elites, toasters, and lipsticked pigs then there was of the 47 million uninsured.
Thankfully, though belatedly, healthcare has made an entrance in the last week. One reason for this is because the candidates’ positions on the financial crisis have been more nuanced than substantive (both supported the bailout, both opposed welfare cheques for CEOs, both transformed into raging populists). Their criticisms of each other have been more personal than policy-oriented. One was “erratic”; the other “phoned it in”. On healthcare, however, the gulf is more apparent.
Naturally, that did not translate into an honest debate automatically. Obama and McCain both sought to paint their opponent’s healthcare plans as radical, outside the mainstream, and unworkable. Meanwhile, they both attempted to present their own as an original solution to a crippling problem that is, at the same time, straight down the middle politically. McCain has invoked the presence of Reagan and the spectre of socialized healthcare when berating Obama’s plan. He frequently argues that the Democrat will plant government in between the citizen and his/her doctor. Conversely, Obama has attempted to portray an out of touch McCain who will endeavour to tax the middle class and turn over more revenue to insurance companies.
Obama has placed greater emphasis on healthcare in his advertising, carefully preying on McCain’s favouring of market solutions and deregulation to somehow create an underlining impression that healthcare will follow the financial system down the tubes if McCain is allowed to touch it. In one ad, entitled “Coin”, Obama and McCain’s positions are juxtaposed in order to carefully carve an impression that Obama stands beside the middle class, while McCain envisages Wall St. solutions for health. In unmistakeably clear language the narrator claims, “McCain would deregulate insurance giants letting them bypass patient protections.” Obama has an acute sense of timing and the power of the word “deregulate” in the current climate is considerable.
The Obama campaign has also made great play of McCain’s proposal to offer a $5,000 tax credit on health insurance. In at least four ads (“Taketh”, “One word”, “Prescription”, and “Can’t explain”) the claim has been advanced that McCain’s tax credit would be transferred directly to insurance companies. Obama has additionally argued that McCain would tax employer based health benefits which amounts to a middle class tax hike. As the Democrat put it in the second presidential debate, “one hand giveth, the other hand taketh away.” He was fully supported by his running mate who argued, with the best line of the vice-presidential debate, that taxing these benefits was “the ultimate bridge to nowhere.”
What then does McCain really propose? Thanks to Healthcare.com there is now a comprehensive and bi-partisan source that breaks down, with clarity and precision, the proposals of both candidates. Fundamentally, McCain intends to lower the total cost of healthcare, and would do so using the market as a hinge or a “lever”. Following this, McCain’s primary avenue for lowering costs will be the creation of greater choice in the healthcare market giving consumers agency. He would indeed introduce a tax on the money company’s pay for their employee’s insurance premiums, with the goal of bridging the gap between employee based healthcare and insurance from other sources. This is predicated on the belief that greater choice will cause costs to plummet. McCain also proposes a $5,000 tax credit for families ($2,500 for individuals) with the aim of reimbursing employees for the rise in company based premiums, or offsetting the costs of a private health plan, depending on which option a citizen elects.
There is no doubt that McCain’s plan is rooted in solid logic and would, as Healthcare.com notes, increase competition and give consumers greater choice. For some Americans, in light of the current economic atmosphere McCain may well be battling history on his market solutions. One potential pitfall is the development of “coverage gaps”. Moreover, those with a diagnosed condition, and those without the financial wherewithal, would struggle to get insurance. To counteract this McCain proposes to use federal and state assistance to aid those afflicted in what is a more complicated aspect of his plan. This might also be where it would unravel in the eyes of conservatives.
Ronald Brownstein of National Journal writes, in a detailed assessment of McCain’s healthcare proposals, that considering so many American’s use employer based health insurance, “McCain would upend that system.” An additional proposal to allow insurance policies from any state be sold in every state would, according to Brownstein, “undercut state laws requiring insurers to cover specific treatments.” On the whole the writer concluded: “The real problem with McCain's idea is that, without the economic incentive provided by the exclusion, more employers might stop offering coverage. And even employers who want to continue could find it difficult because younger workers would be likely to use their credit to buy stripped-down, cheaper coverage on their own. That would leave employers covering only older and sicker workers, which could quickly swell premiums to unaffordable levels.”
In contrast to McCain, Obama has struck an emotional chord with voters on this subject. Whereas McCain has performed quite poorly, Obama has poignantly recounted the days of his ailing mother battling insurance companies. His proposals are predictably compassionate. The primary focus is to greatly increase the levels of coverage. Obama would guarantee coverage for any American or permanent resident who requested it by opening a national health plan based on the system available to employees of the federal government. However, health insurance under the Obama plan is not mandated, as it would have been under Hillary Clinton. For Healthcare.com some of the primary benefits of the Obama plan would be the greater access it would offer the uninsured, and the incentives it would provide for small-businesses to offer health coverage to employees. Moreover, the plan includes “a market-place mechanism for standardizing, regulating and extending coverage for health insurance plans by way of the National Health Insurance Exchange.”
On the downside, Obama’s reforms are seen as so sweeping they would suffer a troubled legislative existence, with congressional passage far from assured even with solid Democratic control of congress. Moreover, it may be difficult to raise the requisite level of funding in the current economic environment. An editorial in the National Review contended, “Obama’s plan amounts to putting the whole country on Medicare, which would reduce the quality of care, empower bureaucrats over doctors and patients, and, quite possibly, bankrupt the federal government.” This argument is effectively along the lines of McCain’s charge that it would put government in between the patient and the doctor.
A supporter might retort, it’s better to have government in the middle than an insurance company. This underscores the fundamental disparity in the approaches of both candidates. McCain’s proposal sees an active role for the market, with the state as a guarantor. Obama, on the other hand, would use the market, but has generally drawn up a plan that would see the state become more of a protagonist. With the financial crisis, McCain’s private sector solutions may seem out of date to some onlookers. Nevertheless, Americans are historically averse to big government, and it is far too early to claim there has been a fundamental shift in outlook on this subject.
There is no appetite for socialized healthcare. It must be stressed that, despite the charges, Obama’s plan is not tantamount to state controlled health services. Greater government involvement yes, but certainly not socialized healthcare. McCain argued at a rally recently, anyone advocating socialized healthcare should travel to Canada or England and take a look at the quality of services there. Funnily enough, Canadians tend to be more proud of their healthcare system than anything else.
Writer Fareed Zakaria draws another link between the two neighbors’ health systems. He asserts that one of the reasons Ontario has outpaced Michigan as North America’s auto-manufacturing hub is because employers are not burdened by the provision of healthcare in Canada as they are in the United States. The candidates are right to focus on how to stimulate business through financial, economic, and tax packages. They would also do well to remember that healthcare is an economic issue too. One does not need to go as far as Zakaria does to see this reality. With premiums becoming so costly and outrageous numbers of people off the radar, healthcare should feature prominently in people’s thinking about who to elect. Similarly, it would be unwise for anyone, voter or candidate, to be too wedded to a particular ideology when thinking of healthcare. Ideological healthcare has proven itself to be a failure on both sides. The rewards will be reaped by whoever harnesses the benefits of all approaches. Even though there is little doubt that the quality of care in the United States is unrivalled, the American healthcare system is broken. The question therefore is not how to improve services so much as access; that should be a priority for voters and prospective presidents alike.
Note: please see Healthcare.com's HealthDecision 08 for a comprehensive and nonpartisan breakdown of Barack Obama and John McCain's healthcare plans.
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