McCain, Obama advisers debate health care

By Brian McNeill

Published: October 1, 2008

Covering more of the nation’s 45 million Americans without health insurance is a top campaign promise by both Democrat Barack Obama and Republican John McCain.

How they would achieve that common goal if elected president, however, is a point of sharp contrast.

Obama wants to expand coverage of the uninsured, make health care more affordable for everyone and require that all children are covered.
“Sen. Obama believes that every person in the United States should have access to health care,” said Dr. Irwin Redlener, a top medical adviser to the Obama campaign and a clinical professor at Columbia University.
Redlener debated McCain medical adviser Dr. William Winkenwerder Jr. on Wednesday in the Dome Room of the Rotunda at the University of Virginia.
Obama’s plan would build on the employer-based health care system that covers 60 percent of Americans by requiring large businesses to either cover their employees or pay into a pool that finances health coverage of the uninsured.

The Democrat’s plan would also allow individuals and small business to buy health insurance from an exchange of government and private providers, much like the system that covers members of Congress.
For low-income people, the government would subsidize their coverage. No one, Redlener said, would be forced to take part in the new system.
Obama’s plan also calls for new rules over the health care industry. For example, Redlener said, health insurance firms would no longer be allowed to deny coverage based on pre-existing conditions.

“Their party will be over, just like Wall Street’s party will be over,” he said.
Winkenwerder, a health care executive and former assistant secretary of defense for health affairs, said that Obama’s plans would place too much of a burden on taxpayers and businesses. Moreover, he said, the nation does not support a new government health care system.
“Sen. Obama’s plan would put us at the doorstep of a single payer health care system,” he said.

McCain’s plan, Winkenwerder said, also aims to expand health coverage, drive down the soaring cost of health care and improve the quality of care.
At the center of the Republican’s plan, he said, is a new refundable $2,500 tax credit to individuals and a $5,000 tax credit to families to help pay for health care. With the average family paying roughly $12,000 for health insurance each year, Winkenwerder said, such a tax credit would make coverage more affordable and greatly expand coverage.

“It would absolutely help people become covered,” he said. “It would expand coverage for 20 to 25 million more Americans.”
The rising cost of health care is a major concern of McCain, he said. In 2000, the nation paid an estimated $1.4 trillion for health care. By 2008, that number had grown to $2.7 trillion.
“It’s scary when you think about it,” he said. “It’s become unaffordable.”
One way McCain would aim to drive down costs, Winkenwerder said, would be to allow individuals to purchase health coverage from other states, increasing competition among health care companies across the country.
Redlener said deregulation is not the answer and that increasing competition has never been shown to drive down health care costs.
A tax credit for health care, Redlener added, would not go particularly far in covering more people because it would only apply to people who could buy health coverage in the first place.
“The basic mechanics of John McCain’s plan does not match the rhetoric of his vision,” Redlener said.
Winkenwerder said that McCain’s plan would be financed by equalizing the tax benefit, enhancing competition and reducing the cost of health care.

The financing for Obama’s plan, Redlener said, would come from cost savings brought about by modernizing the health care system, ending the expensive war in Iraq and rolling back the Bush Administration’s tax cuts for the wealthiest 2 percent of Americans.
“We’re just going to turn the clock back on the individuals who can and should participate a little more to make our country healthier and better,” he said.
In the first few months of an Obama administration, Redlener said, Obama would begin the process of health care reform. Winkenwerder said he doubted that the next president — whether it be McCain or Obama — would be able to tackle such an expensive and complex problem in the first year.

Dr. Tim Garson, UVa’s provost and a health care expert himself, said that he expects health care will continue to stay at the forefront of the presidential campaign and will be a key challenge to be faced by whichever candidate wins on Nov. 4.
“It has been a problem longer than Iraq, longer than $4 gas and longer than subprime mortgages,” Garson said.