Oberlander J. The partisan divide — the McCain and Obama plans for U.S. health care reform. N Engl J Med 2008;359:781-784.
In the face of escalating costs, uneven quality of care, and the growth of the uninsured population, there is broad agreement that the U.S. health care system requires reform. However, Democrats and Republicans remain sharply divided over how to reform it, as evidenced by the health care plans offered by the parties’ presidential candidates. The ambitious reform agendas of Senators John McCain (R-AZ) and Barack Obama (D-IL) would take the U.S. health care system in very different directions.
McCain’s plan embraces market forces and promotes individually purchased insurance (see red box). Its centerpiece is a change in the tax treatment of health insurance. Currently, workers do not pay taxes on health insurance premiums paid by their employers. The McCain plan would eliminate this tax exclusion and use the revenue generated — projected to be $3.6 trillion over 10 years — to pay for refundable tax credits for Americans obtaining private insurance ($2,500 for individuals, $5,000 for families). Uninsured Americans could use their credits to help buy insurance coverage on the individual market, and workers with employer-sponsored insurance could use theirs to offset the cost of paying taxes on their employers’ premium contributions or to purchase coverage on their own.