Good article looking at what the candidates have proposed just far - McCain just announced his plan yesterday, though everyone is paying more attention to the slugfest in the Democratic primary…
Here’s the article - what do people think of the various proposals? I like McCain’s best - but I don’t know about the reimportation of pharmaceuticals, which the article doesn’t mention. If I were a Canadian, I’d be terrified that that would mean that either 1) the Canadian prices would skyrocket, or 2)a) the big pharma companies would pull products or at least inventory from Canada or 2)b) that at the very least, the big pharma companies would be much slower in introducing new products to Canada.
[i]Vital Signs in Health-Care Debate
May 1, 2008
Republican John McCain and Democrats Hillary Clinton and Barack Obama are laboring with understandable vigor to contrast Republican solutions to the ailments of the American health system with Democratic ones. The differences are sharp.
But in some key areas, the two sides are inching away from their traditional corners toward the middle of the ring, a change that’s a necessary step toward getting something done.
Campaign proposals are watercolors, not photographs. Details are often indistinct. Attempts (including mine) to price candidates’ proposals and identify how they’d pay for them inevitably founder on unverifiable assertions, unspecified technicalities and arithmetically accurate, but politically improbable, cost-cutting vows.
In the watercolor version, Sen. McCain would make health care more like the market for everything else, offering vouchers – that is, tax credits – so Americans can shop for health insurance like they shop for cars. Covering everyone isn’t a priority, nor is keeping employers providing insurance; less regulation and less government are priorities.
The Clinton-Obama approach – differences between the two candidates are smaller than they suggest – prizes coverage for nearly everyone. Both would push individuals to buy insurance, press employers to chip in, impose new rules and expand government insurance to fill gaps.
And all three candidates promise pain-free ways to restrain costs. Most aren’t clear money savers, though. If you don’t hear providers yelping about it, it isn’t going to save money, counsels John Sheils of health consulting firm Lewin Group.
But at a Washington forum this week, Len Nichols, a veteran of the failed Clinton health initiative of the 1990s now at the New America Foundation, and Joseph Antos, a Republican economist at the American Enterprise Institute, each ticked off some virtues of the other side’s plan.
Without the class-warfare rhetoric used by Democrats, for instance, Sen. McCain acknowledges inequities in today’s $220 billion-a-year in tax breaks for health insurance. The lucky two-thirds of Americans get health insurance through their employers, but they don’t pay any taxes on the benefit. The break is worth much more to high-bracket taxpayers than low-bracket taxpayers, and worth nothing to those Americans who don’t have health insurance.
Sen. McCain would replace that tax break with a $5,000 tax credit for every family, no matter what their tax bracket or where they get insurance. Take from the rich, give to the bottom half, a Democratic applause line.
This week, Sen. McCain conceded that not everyone who wants to buy insurance under his plan would find it. So he suggested a vaguely articulated network of nonprofit, government-sponsored outfits that would contract with private insurers, set “reasonable limits” on premiums and offer subsidies to low-income families. That’s far from Hillary Clinton’s 1993 “health alliances,” and definitely not universal coverage, but an admission that the market can’t do the job alone.
Democrats, meanwhile, have moved away from the 1993 Clinton approach. “They have elements of consumerism that might surprise people,” Mr. Antos says. They have moved toward Republicans in proposing to subsidize individuals so they can shop for insurance; they emphasize more than ever the virtues of people choosing from among competing health plans.
And, though he accuses Democrats of low-balling the price tag, Mr. Antos praises them for acknowledging that expanding access to health care will cost money. Indeed, Sen. Clinton’s first campaign speech on health, in May 2007, focused not on universal coverage, but on costs. “I think we finally have a recognition that everyone sees there is an economic imperative to rein in costs,” she said.
Paying for those costs? Well, Mr. Antos (and, privately, some Democratic analysts) translates Democratic candidates’ rhetoric this way: “We’re going to get rid of the Bush tax cuts and do that as many times as necessary to pay for all this stuff.”
Not to worry. There’s still plenty to argue about. By eschewing the hugely popular goal of nearly universal coverage – which means making sure the poor can afford insurance they want and the young and healthy are forced to buy it even though they think themselves immortal – Sen. McCain fuels the debate over “whether” to expand coverage, instead of how to do it.
Mr. Nichols says that Sen. McCain’s plan to allow people in one state to buy individual insurance in another – essentially deregulating this part of the insurance market – amounts to “ideology trumping policy.” Rational insurers will attract the healthy with low premiums and boost premiums for those with pre-existing conditions. “Fifty to 75 million Americans will discover what ‘actuarially fair’ really means,” he says. (Sharply higher premiums.) The result, he predicts, will be a rush to Medicare-for-all that Republicans will hate.
Mr. Antos counters by focusing on the Clinton-Obama proposals for forcing private insurers to compete against expanded government health-insurance plans. The government’s muscle is so great it will dictate prices to hospitals and doctors below those offered to private insurers, he warns. "Clinton and Obama tie the hands of private insurers, and then say ‘let’s have a race,’ " he complains. The result, he predicts, will be a rush to a government-run health-care plan that he suspects many Democrats long for.
The moment of compromise isn’t at hand; voters are offered a choice between two fundamentally different approaches. But behind the rhetoric, there’s movement.
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