You may have heard that there is a presidential election this year. As the election draws near it may be useful to take a look at the issue of access to health care. This article will examine the positions of Barack Obama and John McCain.

Keep in mind these facts: nationwide spending on health care has exceeded $2 trillion annually; and the national average yearly cost of a comprehensive family plan rose in 2007 to $13,000 from $12,000. 

A comparison of Obama’s and McCain’s positions on health care appears in the box below this article.

ANALYSIS

Some see strengths in the McCain plan. Allowing interstate insurance sales may relieve companies from complying with state mandates such as mental health parity, which adds to costs. Inclusion of mental health coverage, however, is an important issue for many families. Encouraging individuals to buy their own plans may make them more sensitive to what their care costs, although it may mean they put off needed care. Lump-sum payments for treatment programs may discourage wasteful spending on unnecessary procedures.

Potential political pluses include ending the tax exemption of employer-provided benefits, which may seem fair to those with no access to such benefits, and uncoupling health insurance from employment, which may make people feel freer to change jobs. 

There are weaknesses. Allowing interstate sales may water down consumer protections in certain states and allow “cherry picking” enrollment of only healthy people in the plans. The Guaranteed Access Plan will probably attract the sickest and oldest in the population, creating a high-risk pool and driving up costs. The $5,000 tax exemption will not cover the $13,000 cost of a family plan. Taxing employer health benefits will be a new tax on workers who participate in plans such as the Local 802 Health Fund, which could depress the fund just when it is on better footing. It could also make it harder for group plans to bargain for better prices. This may also discourage employers from offering health benefits, leaving workers to the mercy of the open market. Research from the Dartmouth Medical School has shown that the laws of supply and demand in the private market do not work for health care; that means that the direction of this plan may not be a good one.

Strengths of the Obama plan lie in accessibility. Mandated child coverage and beefed up SCHIP and Medicaid will draw more children into the system. Allowing coverage to age 25 on the parent’s plan will help extend this into adulthood. The public plan and new federal subsidies will make it easier for sicker people to get affordable coverage. Allowing Medicare to negotiate with drug companies and putting Medicare Advantage on equal footing with traditional Medicare should ensure that the public sector is competing on a level playing field with the private sector. This is a step toward the systems in other countries, where more people are covered and the government plays more of a role, a direction that a growing number of people think we need to take. Almost 50 percent of health care is paid with public funds now, so one could make the argument that most of us are paying twice: our own premiums, and taxes to cover other people.

Cost may be a weakness. The new public plan may attract the sickest and oldest if not enough private plans participate in the National Health Insurance Exchange. 

A weakness both plans share involves adverse selection. This arises when people are allowed to opt in and out of coverage. Not requiring everyone to be insured leads to mostly sicker people enrolling while the healthier remain outside the system, increasing costs. Also, what do we do with someone without coverage who becomes seriously ill? Additionally, neither plan addresses the shortage of primary care givers, a problem plaguing Massachusetts in the second year of its attempt at universal health care.

Universal access to health care will prove difficult to achieve. If we eliminate private insurance tomorrow and install a single payer system, it will save money. However, the lion’s share of health care costs is for the care itself. We will need to find ways to control those costs.

Local 802 and the AFM have adopted a resolution in favor of universal health care because of the importance of the issue — and 802 has officially endorsed Obama because it feels his plan comes closest.

In other countries, universal health care is achieved by variations on a theme: everyone participates and everyone is covered. This happens by either requiring everyone to buy in (Japan and Germany) or with a broad tax (the U.K. and Canada).

Neither Obama or McCain go that far. We need to decide who comes the closest — and we must remember there will be more work to do after the election.