ISSUE IN-DEPTH: HEALTH CARE: IN THEIR OWN WORDS …

BARACK OBAMA (Bristol, Va., June 2008)

Let’s be honest —- we’ve been talking about this for a long time. Year after year, election after election, candidates make promises about fixing health care and cutting costs. And then they go back to Washington, and nothing changes —- because the big drug and insurance companies write another check or because lobbyists use their clout to block reform.

It’s time to finally challenge the special interests and provide universal health care for all. I believe that health care should be guaranteed for every American who wants it and affordable for every American who needs it.

And this is an area where John McCain and I have a fundamental disagreement. We know that since George Bush took office, premiums have gone up four times faster than wages, and Virginia families are now paying over 35 percent more for health care. Seven million more Americans are uninsured, including nearly 200,000 here in Virginia. Yet John McCain actually wants to double down on the failed policies that have done so little to help ordinary Americans.

Like George Bush, Senator McCain has a plan that only takes care of the healthy and the wealthy. Instead of offering a comprehensive plan to cover all Americans and control rising costs, he’s offering a tax cut that doesn’t even amount to half of the cost of an average family health care plan and won’t make health care affordable for the hardworking Americans who need help most.

But it’s not just that his plan won’t help reduce costs; it could actually drive costs up. Senator McCain’s plan would weaken the employer-based system that most Americans count on for health care. It’s a plan that could subject your coverage to the whims of the market, generate up to $20 billion in new administrative costs and actually put health care costs out of reach for even more older workers, even more sick Americans and even more families.

In an Obama administration, we’ll lower premiums by up to $2,500 for a typical family per year. And we’ll do it by investing in disease prevention, not just disease management; by investing in a paperless health care system to reduce administrative costs; and by covering every single American and making sure that they can take their health care with them if they lose their job. We’ll also reduce costs for business and their workers by picking up the tab for some of the most expensive illnesses. And we won’t do all this 20 years from now, or 10 years from now. We’ll do it by the end of my first term as president of the United States.

So the American people will have a clear choice on health care. We can either extend the Bush policies that we know don’t work; or at this moment, in this election, we can come together and say enough is enough, we’re going to finally solve this problem once and for all.

JOHN McCAIN (Cleveland, May 2008)

Underlying the many things that trouble our health care system are the fundamental problems of cost and access. Rising costs hurt those who have insurance by making it more expensive to keep. They hurt those who don’t have insurance by making it even harder to obtain. Rising health care costs hurt employers and the self-employed alike. And in the end they threaten serious and lasting harm to the entire American economy.

These rising costs are by no means always accompanied by better quality in care or coverage. In many respects the system has remained less reliable, less efficient, more disorganized and prone to error even as it becomes more expensive.

There are those who are convinced that the solution is to move closer to a nationalized health care system. They urge universal coverage, with all the tax increases, new mandates and government regulation that come along with that idea. But in the end this will accomplish one thing only. We will replace the inefficiency, irrationality and uncontrolled costs of the current system with the inefficiency, irrationality and uncontrolled costs of a government monopoly. We’ll have all the problems, and more, of private health care —- rigid rules, long waits and lack of choices, and risk degrading its great strengths and advantages, including the innovation and lifesaving technology that make American medicine the most advanced in the world.

I have a different vision. The key to real reform is to restore control over our health care system to the patients themselves. …

When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices. But for every American who wanted it, another option would be available: Every year, they would receive a $5,000 tax credit directly, with the same cash value of the credits for employees in big companies, in a small business, or self-employed.

You simply choose the insurance provider that suits you best. … The health plan you chose would be as good as any that an employer could choose for you. It would be yours and your family’s health care plan, and yours to keep. …

Families also place a high value on quickly getting simple care and have shown a willingness to pay cash to get it. If walk-in clinics in retail outlets are the most convenient, cost-effective way for families to safely meet simple needs, then no policies of government should stand in their way. … We need to find ways to organize patient data to make information accessible and useful, allow patients to manage their medical records and still protect the privacy of health information.

These innovations are an inspiration and a reminder of all that’s good in American health care. We need that reminder sometimes in Washington.

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THE McCAIN PLAN

> Tax recipients of many employer-sponsored health plans and provide a $2,500 tax credit for individuals ($5,000 for families) as an incentive to purchase private health coverage.

> Encourage competition among private insurance providers by allowing plans to be sold across state lines. Administrative costs would be reduced by selling policies nationwide instead of being regulated by the states.

> Work with states to create a federally subsidized plan for anyone denied coverage because of a pre-existing condition. The subsidy amount would vary by income.

> Require drug companies to reveal the price of their drugs; encourage faster introduction of generics and allow “reimportation” of cheaper drugs from other countries.

> Change provider payments to encourage coordinated care, such as paying a single bill for coronary care rather than individual bills to a cardiologist, internist and other providers who specialize in heart care.

> Establish national standards for treatment measurements and use technology to share information on best practices.

THE OBAMA PLAN

> Require coverage for all children, using a combination of private plans as well as expansion of Medicaid and state children’s health plans.

> Require employers to offer “meaningful” coverage or contribute a percentage of their payroll toward the cost of a public plan. (Small businesses would be exempt from this requirement.)

> Create a new national plan so that small businesses and individuals without insurance would have access to affordable coverage. The plan would be modeled after coverage available to federal employees. Coverage would be tied to the individual or family and portable between employers.

> Prohibit insurers from denying coverage based on pre-existing conditions.

> Invest $50 billion toward adoption of electronic medical records and other health care IT products.

> Pay for treatment under Medicare Advantage plans at the same rate paid under traditional Medicare coverage.

> Expand funding to increase the ranks of primary care physicians and public health nurses and physician assistants, including loan repayments, improved reimbursement and training grants.