McCain and Obama on Health Care

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As the punch, counter-punch continued on the presidential campaign trail yesterday, health care advisers to Senator Barack Obama and Senator John McCain stuck to the issues at a Harvard School of Public Health forum. David Cutler (Obama) and Gail Wilensky (McCain) laid out their candidates’ plans and took a few questions.

An Overview
There is some agreement from each camp about the importance of electronic health records, tying what we pay hospitals and doctors to the quality of their work and medical malpractice reform.

Cutler and Wilensky disagree on how to cover the uninsured and how important that issue would be. Cutler says, for Obama, health care is no. 2 behind Iraq. Wilensky would not say if getting coverage for everyone is one of McCain’s goals. She said Iraq, other national security issues and the economy are McCain’s top priorities. But she stressed that he is only Republican for some time with a serious health plan.

The two advisers each say the other candidate is not putting up enough money to fund his health care plan. Cutler says McCain can’t stick with or expand the Bush tax cuts AND balance the budget without major cuts in health care programs. Wilensky says Obama is pledging to spend the same money from reversing some of those tax cuts for a number of major initiatives.

At the forum, Cutler spoke first. He described Obama’s health care plan in 3 parts:

1) Universal Coverage – says there are 2 reasons why the uninsured don’t have coverage. They either can’t afford it or don’t know where to get it.

Obama pledges to lower the cost of insurance by eliminating duplication and waste. He would fund expanded coverage by getting rid of the tax breaks President Bush delivered to Americans who earn more than $250,000 a year. And Obama would create something like the Massachusetts Health Connector to help individuals and small business get more affordable care. He would not make insurance mandatory for adults. Cutler says the uninsured will buy in if health plans are accessible and affordable; work on that first and consider a mandate later, if needed.

2) Need to modernize the health care system to reduce costs, improve the health of Americans and making medicine a more appealing profession. Cutler says Obama would stress prevention, invest in electronic medical records, and pay for quality, effective care, not just more of what we have now.

3) Need a public health system that works with the medical system to prevent disease and improve health

Cutler says Obama’s plan will:

1) cover 98-99% of Americans (many in Massachusetts are skeptical he could do that without a mandate)
2) cut costs for families by $2500 a year (that’s about 20% in MA). Wilensky says the idea that Obama could achieve such savings in his first term “belies credibility.”
3) expand employer based coverage by about 10 million
4) create a more rewarding environment for doctors (especially those in primary care).

Wilensky’s presentation focused on changing the tax code. McCain would get rid of the pre-tax exemption for insurance employees receive when they buy into an employer’s health plan. He would replace that exemption with a partial tax credit for individuals and families who buy health insurance on their own. Wilensky says this approach will:

1) make individuals more aware of the cost of health insurance
2) create a fair playing field so that all employees get the same health insurance tax break
3) give individuals more plans to choose from

Wilensky responded to critics who say employers will stop offering coverage if the tax incentives disappear. She says midsize to large companies will still see health insurance as an important benefit in recruiting and retaining workers.

McCain would subsidize coverage for Americans who are really sick, need a lot of health care and drive up rates for everyone.

Wilensky acknowledges that McCain would have a hard time persuading a House and Senate controlled by Democrats to change the tax code on health insurance. But she argues McCain has a much stronger record of working across the aisle on bi-partisan bills. Several times, Wilensky asked the audience to remember the opportunity that was squandered in 1993 (President Clinton’s health care bill) and not let that happen again.

There were a couple of questions on Medicare, where costs are expected to double by 2017. Cutler and Wilensky went back to their comments about starting to slow the growth of health care spending.

Martha Bebinger

This program aired on September 14, 2008. The audio for this program is not available.