Our health care system is a mess.
Most of us confront it less often than we fill our gas tanks, but we know that 46 million of us are priced out of health insurance.
We know that we pay almost twice what other developed countries do — and still die younger. And so we know that something is very wrong — and getting worse.
Sen. John McCain’s plan focuses heavily on insurance costs.
To fund it, he would tax workers on the premiums that employers have provided as a tax-free benefit since World War II. He would use that money ($3.6 trillion over 10 years) to give individuals a $2,500 tax credit to buy insurance on their own.
This is a poor idea. Why?
Because few of us know enough to bargain effectively with insurers, and because insurance works best when it spreads risks over large groups (as Medicare does).
Because individuals typically pay more than groups — and because $2,500 won’t buy much coverage.
Because many would be tempted to forgo necessary care. And finally, because most of those 46 million uninsured would stay uninsured.
McCain ignores our biggest costs — which those insurers simply pass on to us — like drug prices, administrative complexity and overtreatment.
His plan throws billions at a fundamentally broken system. It shifts costs but doesn’t add value. Like his summer gas-tax holiday, it’s catchy, simplistic and shortsighted.
Obama starts with a bigger goal — to insure everyone — and works backward to pay for it. He sees a bigger problem, and so can see a better solution.
He creates a new national health plan (similar to Medicare) as an option for the uninsured and for small businesses. He insists that all children be covered.
He addresses insurance costs by requiring insurers to reduce administrative overhead. He requires most businesses to offer workers insurance or pay a tax to cover its cost.
Obama allows Medicare to negotiate prices with drug companies. He attacks the cost of new high-technology treatments with an agency charged with learning which innovations really improve on current treatments, and releasing only those to market.
He funds his plans by reversing the Bush tax cuts for families making more than $250,000 per year.
Cutting costs will be a huge political challenge, requiring a galvanized citizenry and unprecedented shared sacrifice from an industry that accounts for a sixth of our economy.
Obama’s plan doesn’t address all our problems, but its scope does match the issue’s gravity. And it does make the moral imperative of universal coverage a political imperative for us all.
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