Sens. Barack Obama and John McCain are gearing up for a general election battle — barring a surprise surge by Sen. Hillary Clinton — in which they will offer very different visions for health care reform.
Obama — like Clinton — sees a much larger role for government in the one-sixth of our economy represented by the health sector. Obama would mandate that all children have health insurance, would require employers to pay for insurance for their workers, would impose significant new federal regulation over health insurance and would expand government programs such as Medicaid.
McCain has a very different vision. "The key to real reform is to restore control over our health care system to the patients themselves," he said recently.
He would focus on new financing tools to help people buy health insurance that would be portable from job to job, new mechanisms for those with pre-existing conditions to get coverage, and he would emphasize prevention and better care coordination, especially for people with chronic illnesses.
Obama and McCain agree the key to health reform is getting costs under control. "The reason Americans don't have health insurance isn't because they don't want it, it's because they can't afford it," Obama says. As a result, neither candidate supports a universal mandate for health insurance.
But Obama would lock in the employment-based system with new mandates on employers.
McCain sees a world in which, "Americans (have) new choices beyond those offered in employment-based coverage." He believes that "Americans want a system built so wherever you go and wherever you work, your health plan goes with you."
McCain would boost options for individually owned health insurance by making everyone eligible for a refundable tax credit to help them buy health insurance. He would allow people to purchase health insurance across state lines and would give states new incentives and resources to make sure everyone has access to coverage. He says that bringing millions of new buyers into the health care marketplace will expand competition and force insurers and providers to offer more affordable options.
Obama believes government should require insurers to accept all applicants and would force insurers to charge basically the same premium for everyone, regardless of age, gender, occupation or pre-existing conditions. A healthy young person would pay about the same as a 62-year-old with heart disease and diabetes.
Obama wants a national "pay or play" mandate, forcing employers to cover a preset percentage of their workers' health insurance or pay a fine. Some businesses would be partially subsidized, but that would mean significant federal oversight of all employer health spending.
He would expand Medicaid and the State Children's Health Insurance Program and would create a new program modeled on Medicare. That would force private health plans to compete with a taxpayer-supported public insurance program, which has federal policing authority and the ability to impose price controls — hardly a level playing field.
Congress will wrestle with the intricacies of reform, but in this election year, the vision is the key, and the contrast between the visions that Obama and McCain offer is stark. The bottom line question will be whether individuals or government will be in control of health care in the future.
Grace-Marie Turner is president of the Galen Institute, a nonprofit research organization focusing on free-market solutions to health reform. She is speaking Tuesday at Washington Policy Center's sixth annual health care conference at the Sea-Tac Doubletree Hotel. For more information call 206-937-9691 or visit washingtonpolicy.org.