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TechnoratiBarack Care vs. John Care: Health Care Under the Next President
By far the most important domestic policy issue facing the next president will be fixing the health care system. The United States stands out among wealthy countries in not guaranteeing health insurance to its citizens.
Yet, even though many people cannot get access to care, we still pay more than twice as much per person as the average in other wealthy countries. And we have the worst outcomes. Only a severely over-medicated politician would claim we have the best health care system in the world.
As bad as the current system is, it keeps getting worse. The number of people who are uninsured year round is at 47 million and rising. The costs also keep rising. Companies are increasingly dropping insurance for their workers, or forcing workers to pick up a larger share of the bill. The explosion of health care costs is the basis for all the scare stories that budget hawks use to cut "entitlements." Since half of the country's health care costs are paid by the government, if we don't fix the health care system, it will eventually destroy the economy -- and also lead to very scary budget deficits.
So, what do the candidates offer? Following in the Republican tradition of referring to health care plans by the first name of their principle backer, let's see what the candidates propose.
John-Care is a plan to get rid of the employer-based insurance that most of us rely on presently. Senator McCain would eliminate the tax deductibility of employer-provided insurance, in effect, requiring employers who offer insurance to take money out of workers' paychecks for their tax liability on their health insurance.
Needless to say, this will make dealing with insurers even less attractive to businesses. Most employers will soon get out of the health insurance business and leave it to workers to buy their own plan. Toward this end, John-Care would give every worker a $2,500 tax credit, or $5,000 for a family.
This will not be sufficient to cover the cost of insurance for many families, especially those with serious health problems. Insurance companies don't like to insure people in bad health. While John-Care does provide a modest pool (at $7 billion to $10 billion) to help people with health problems to get insurance, this is a tiny fraction of what would be needed. Essentially, the McCain plan would undermine the current employer-provided system, and leave millions of people with health problems unable to buy insurance.
By contrast, Barack-Care would build on the current system. It would create a publicly run Medicare-type plan that any employer or individual can buy into. This would provide an additional option for people unhappy with their current insurance. However, those who are pleased with their current insurance would be able to stay with their plan under Barack-Care.
Barack-Care would also reform the private market, prohibiting insurers from charging more to people with health conditions, a rule that is already in place in several states. This would mean workers need not fear being unable to get insurance if they develop a serious illness and lose their job.
Barack-Care would also have subsidies for low- and moderate-income families to ensure they can afford to buy insurance. These subsidies would be financed by a fee assessed on employers who don't provide insurance. The basic story is that every employer (with a small business exemption) will have to contribute towards their workers' health care. They can either buy insurance directly, or they can contribute to a general fund to pay for insurance.
So, those are the basic outlines of the two candidates' health care plans. Senator Obama would build on the system that is already in place and offer people an additional option -- buying into a Medicare-type public plan. By contrast, Senator McCain wants to get rid of the current system of employer-provided insurance and force everyone to buy insurance as individuals.
In terms of health care policy, this is by far the sharpest difference between presidential nominees the country has ever seen. Hopefully, people will be aware of these distinctions when they cast their votes in November.
Dean Baker is the co-director of the Center for Economic and Policy Research (CEPR). He is the author of "The Conservative Nanny State: How the Wealthy Use the Government to Stay Rich and Get Richer" (www.conservativenannystate.org). He also has a blog, "Beat the Press," where he discusses the media's coverage of economic issues. You can find it at the American Prospect's web site.
27 Comments so far
Show AllIf these are two radically different ideas....we are in big trouble....I see very little difference in the two and fankly using private delivery SUCKS!
Clifford makes a good point. Both candidates "propose to leave the for-profit health insurance industry smack dab in the middle of the system" and "the countries with efficient health plans eliminated these profiteers."
Those countries had to eliminate private insurers to control costs and keep the system financially viable.
Like Dean Baker himself once put it:
"Basically, anyone who is not serious about controlling health-care costs is not serious about providing universal coverage. It's that simple."
quote form Corporate America and Healthcare Reform By Roger Bybee
I'd like to see a single-payer system be implemented immediately. However, I will take Barack-Care until we can persuade Congress that it will be more politically expedient to submit to the wishes of REAL people rather than the fake (corporate) "persons" and their knee-jerk conservative buddies and to enact a single-payer system. I'm 55 years old, worked hard all my life and continue to work, but I do not make enough money to afford the prohibitive premiums (even if the companies would "allow" me to join them), and therefore have no health insurance. We need to take whatever we can get, then bitch and scream and demand more after we elect someone that will, at last, listen.
skinnycat July 1st, 2008 11:14 am
Good points there.
Don't forget the real power resides in Congress, not the Presidency or the Supreme Court. So Obama and McCain don't have the real last word.
Yes, Dean Baker is one of the good economists. But single-payer health care is much better and more honest than what John Obama and Barrack McCain are trying to sell. Single payer can be paid for with a Tobin tax a nickel at a time. No pain. No strain. No burden on anyone. No insurance companies. No employers. If the employers who now provide health care don't give the workers a raise they will pay higher taxes since they won't have a health care deduction anymore.
When the elections are over a chorus of pinchpennies will say the US is too deep in debt to do anything on healthcare. Don't believe it. When England did national health care ( The National Health Services Act of 1948) it had a mountain of WW II debt, and food was rationed. Congress should fully fund single payer health care with a tax on financial transactions, to include currency, stock, credit card and ATM transactions.
If you really want change, vote outside the two party system. Nader is the most democratic candidate running.
If you don't like NAFTA and the WTO you will love Senate Bill S.3083. Thank you Senator Brown and Rep. Michard - HR6180.
Both Obama and McCain propose to leave the for-profit health insurance industry smack dab in the middle of the system. That is the problem. The countries with efficient health plans eliminated these profiteers. Once again our two party system has failed to offer voters a choice.
Ronald White, there is absolutely NO DOUBT that "American voters are too stupid to see through the smear campaign and stupid enough to reject a health care system that is only slightly approaching the fully-socialist health-care systems which makes Norway's , Finland's , France's… citizens , generally the happiest , healthiest , and on average the richest in the world."
Daniel David June 30th, 2008 7:58 pm
DD, I agree with your points. Unfortunately, there are a lot people posting here on CD that are profoundly ignorant, not just on the issues surrounding health care, but also the issues regarding the power of the office of president, and why we must do whatever it takes to keep "Insane Grampy McSame" OUT OF IT!!
I forgot to add the Finnish , French , Norwegian ... downside : they're drowning in taxes but they can see what they are getting for those taxes and generally concur
"There is just too much power in the inevitable attack ads saying that a government takeover means your health care will be run like your post office, your license bureau or FEMA at Katrina."
What you are admitting , Daniel David , is that American voters are too stupid to see through the smear campaign and stupid enough to reject a health care system that is only slightly approaching the fully-socialist health-care systems which makes Norway's , Finland's , France's... citizens , generally the happiest , healthiest , and on average the richest in the world .
If they are as stupid as you think they are to be duped again then Americans absolutely deserve the best DMO ( death-management organizations ) you've got .
Your citizens are dying but those citizens themselves and the polititians gag on the concept of life-saving socialist healthcare .
Ya gotta admit , it's a good way to keep the rabble under control ; just let them die .
Re: Daniel David June 30th, 2008 7:58 pm
Your first point is losing what mojo it had at an accelerating pace. Politics of fear is not as effective as a progressive politics, many policies of which have polled in the lead. There's a lot to be said for speaking truth to people, but Obama's rhetoric is swayed more and more by his corporate backers. He won't and can't cross them.
Your second point is the strongest one, but without knowing more details of the Obama healthcare plan, we don't know if the extra billions collected from unwilling business insurers will be enough to cover the "medicare" optionees and enough to kickstart a self-feeding loop in that direction. I think you make good points about the excessive marketing costs, but will the "medicare" option be truly viable or will it be emasculated?
As to your third point: Bush is managing to enact many plans "over the wishes" of a Dem Congress. We all know what the Beltway gravitation to the center does.
Bear in mind that Obama is not talking about single-payer in an election BECAUSE all candidates who do so get beat badly. There is just too much power in the inevitable attack ads saying that a government takeover means your health care will be run like your post office, your license bureau or FEMA at Katrina.
Bear also in mind that Obama's idea for a medicare-style choice you can buy into WITHOUT medical underwriting is very similar to single-payer for those who choose it. It WILL render private insurance uncompetitive over time, because it will not be burdened with excessive marketing costs (ads and sales commissions) or the excessive risks of your own medical history.
Bear thirdly in mind that McCain CANNOT enact any plan over the wishes of a Dem Congress. He can only veto THEIR initiatives. Obama, on the other hand can sign them.
The notion, expressed by some, that it doesn't matter which one we elect is profoundly ignorant of actual health care universe.
No insurance company would sell me a policy at any price. I have an artificial heart valve, asthma, sleep apnea, high blood pressure, nasal allergies, surgeries on both knees, shoulder and several other surgeries.
My wife's employer is stuck with me as an insurance liability. She works for the state of Wisconsin show she still has a job. Universal health care is the only chance that I personally have for a good job and health care. My master's degree in education and BS in an engineering field, teaching, supervisory and engineering experience will just go to waste. Even paid headhunters will not try to market me.
SINGLE PAYER IS THE ONLY ONE THAT "WORKS."
It would seem that Dean Baker, a wonderful economist, is suggesting that voting for a system that isn't as broken as the other system, but still broken, should factor into my vote. My apologies, but even with my health insurance from my employer, my HMO can cut me out anytime they wish. Nationalize insurance. Now. Lucky for me, I have another choice, not mentioned. Ralph Nader and Cynthia McKinney both support single-payer health insurance, and therefore they are the only two choices I can possibly fathom on this, the most important domestic issue (although there are many).
This should not even BE an issue. Conservative, Liberal, single payer is the only way to go if you own a conscience of any kind.
@ Smilodon1,
Now we'd need to copy Taiwan's version of Medicare to get it back to what it was in 1995. Medicare has been partially privatized and damaged by a government with a yearning toward ignoring the Preamble's command to "promote the general welfare."
"DOGFACE" has it right.
McCain's idea is terrible.
Obama's is better, but not much.
Obama is starting to show that he is all talk.
When you look at his policies, there isn't any "Change" there.
National health insurance is the only answer
...and Hillary-Care had all the O-care attributes plus a single payer option - Medicare for everyone.
As Smilodon1 suggests this is by far the best option of all.
Taiwan instituted a national healthcare plan in 1995. Every taiwanese is covered 100%. The Taiwan government looked at medical plans in a variety of countries and then copied one that was the most successful. They copied the US Medicare plan. I wonder why we can't do the same?
As an aside, neither candidate mentions dental care as part of health care. I wonder why? Dental care is certainly a healthcare expense for most people and most dental plans are terrible.
What's to discuss? Private run health care has failed this country miserably in terms of cost and benefit. We need to follow the lead of more enlightened nations and move toward national health care. No brainer.
It is amazing that a good many Americans refuse to realize paying a wee tax for a national, single-payer, health care plan is far less than the bundle they pay for health insurance that usually amounts to limited health insurance.
I'm not comfortable with either presidential candidate . . . and even more so with a Congress that refuses to hold Bush-Cheney accountable for crimes against the US and its citizens.
July 4th should be a day of mourning for the millions slaughtered because of LIES of the Bush administration with the support of congress.
The founders of our beloved country would have dealt with such ________ swiftly.
Dean Baker is a wonderful economist and writer. His articles provide an ongoing education in economics.
However, "by far the most important domestic policy issue facing the next president" will be the restoration of constitutional government.
The biggest political forces against a government-run national health care system is the insurance and pharmaceutical industries. A majority of physicians are for a national health insurance program, even though the AMA is not. This should tell you something.
Its simple. Single payer basic health care sysetm is the only way to go.
In the US 18,000 die every year because of lack of access to health care. That is like having a 9/11 every 60 days. Both, the Democrats and the Republicans are controlled by the insurance companies.
Only Nader supports The Single Payer System -which would save money and lives. Any voter who does not vote for Nader, is complicit in the 18,000 deaths.
i like Dean Baker...
However, did not the Democrats learn their lessons with the election of Bill
Clinton as President of the United States? Like the Clintons before him,
Mr. Obama is slowly moving to the 'RIGHT"? Only he is moving to the center
even before being elected. "Hope", is a word. It is a desire not an action.
It all sounds so very noble when he states it. Dear preacher-man, we cannot
just "hope" our lives away. We need direct action on behalf of the people
of this country.
Mr. Obama is going forward, or I should I say "rightward" with policies
favorable to the corporations and a very fast moving repressive Government.
Can you say FISA? Can you say not asking for the repeal of the MILITARY
COMMISSIONS ACT? Can you say where is my Habeas Corpus? Can you say "maybe"
we will keep torture around a little longer 'cause we "needs" it to protect
Amerika from terrorists? Therefore, so goes the moral wealth of this
nation.
Trust me; I completely reject John McCain and his so-called policies that
seem to change like a feather in the wind. I am quite sure that Grumpy
McCain is totally senile and I have no doubt that he is a woman hater. It
is rather obvious that he hasn't a clue about world affairs or how to deal
with people in a diplomatic manner. There will not be a future for this
country if this man is elected.
As far as the democratic candidate goes, how many times in one's life time
can you let charisma trump justice? I have no doubt, that he, Mr. Obama
will be elected. However, the people of this country have lost their will to
stand up and demand that justice be serviced. He is OUR servant, not we his.
We the people, need the will to hold him accountable for what passes as the
"rule of law" now-a-days in the White House, and no one can do that by
sitting on their duffs and watching those great mind numbing "reality-TV"
shows.
As the corporations tighten their grip on Mr. Obama and his family, we will
continue to see no energy policies to speak of, no single payer healthcare
plan, higher food prices, and the waging of continuous wars in the name of
profit.
I just heard that Medicare payments would be cut by 10% this July. Anyone
for getting in Congress' face over this one? In case you do not understand
what this means..talk to you doctors. They will be paid less for their
services. Now there is a great incentive for giving you a higher quality of
healthcare. Why don't you ask Mr. Obama what he intends to do about this. Do
not take an answer like, when we get into the White House.. We "hope"
to...???? Where's your plan?
The reality of these polices will reach the more affluent later than it has
reached the rest of us. Your time is running out, you are next. No man is an
island and global warming shall fix that.
Consequently, for people like me, we STILL hold our noses and vote for the
lesser of the two evils because there are no real choices. We get what we
vote for. Or, maybe my vote depends on what the previous dynasties will
allow. Does my vote still count?
I guess not. When our votes were stolen in 2000 and 2004, there was no big
uprising or a demand for justice. I'm sorry, I will never just get over it!
I will never ever again put my faith in Al Gore .If you have watched his
actions in congress in the movie Fahrenheit 911, you can see how Gore told
the black states representatives trying to register their formal complaints
on voting irregularities "just sit down and be quite". He totally ignored
their requests to be heard and given relief by their government.
That's what passes for democracy these days in this country. God have mercy
on us all.
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"It's called the American Dream because you have to be asleep to believe
it." - George Carlin - June 22, 2008 - Rest in peace.
Assumes too much. No inevitability either of these two will get in. Where is the discussion of alternative candidates?
Take 2 cyanide tablets and call me in the morning.