Obama v. McCain on health care. Part 2: Requirement to obtain or offer coverage
September 10th, 2008 by 
David E. Williams of the Health business blog
In Part 1 of this series I outlined my intention to compare the presidential candidates’ positions on health care using the Kaiser Family Foundation’s health08.org framework. In this post I assess part A: “Requirement to obtain or offer coverage.”
First, here is the Kaiser summary:
McCain
- No provision.
- Opposes mandate for coverage.
Obama
- Require all children to have health insurance.
- Require employers to offer “meaningful” coverage or contribute a percentage of payroll toward the costs of the public plan; small businesses will be exempt from this requirement.
During the Democratic primary, mandatory purchase of health insurance by individuals was the biggest point of difference between Obama and Clinton. Clinton wanted mandatory coverage for everyone, while Obama said ‘kids only.’ It was a fairly brave and principled position by Obama, reflecting a nuanced understanding of the health care environment but leaving Obama vulnerable to Clinton’s charge that her plan would cover everyone while Obama’s wouldn’t.McCain’s stance is principled, too. His goal is make insurance available to everyone but not force people to buy something they don’t want.
I prefer Obama’s position on this one. He picked a goal that is ambitious yet achievable, and one where there is a lot of common ground. Clinton’s universal mandate wouldn’t have worked because there are too many uninsured people. Even in Massachusetts –a rich state that started with a high percentage of people already insured– it’s proving very expensive and difficult to achieve universal coverage through mandates. Nationally it’s impossible.
I respect McCain’s position that people shouldn’t be forced to buy coverage, but kids are different than adults. They definitely should have access to care, and the best way to do that is to get everyone covered up front so there are no access problems when a child gets sick. Childhood is the time to lay the foundation for good health and wellness; an important part of that is regular access to a pediatrician. Maybe McCain opposes mandates for kids because he’s worried about a slippery slope toward mandates for adults, but I don’t think it’s great policy.
Turning now to mandates for employers to offer coverage, I don’t favor one candidate over the other. Neither one’s position is likely to have any real impact.
In general employers should pursue profit maximization, growth and shareholder value without regard to social policy. That maximizes wealth generation, which can be used to fund social programs including health insurance. Mandates are a hidden tax on companies, which tend to mask the real cost to the economy. On the other hand, almost 100 percent of larger employers provide health insurance now, so a mandate or lack thereof is pretty much irrelevant.
Neither McCain nor Obama require anything of small companies, which is where the uninsured employees are.
Please read Part 3: Expansion of public programs.
Posted in Policy and politics | 
4 Comments »
September 16th, 2008 at 12:02 am
[...] I’m sure most of us are going to need a stiff drink to calm our tired brain after this election season. David E. Williams from the Health Business Blog has been busy comparing the Obama and McCain health plans. His post is very informative and I encourage you to read it before you cast your vote for the candidate of your choice. [...]
September 17th, 2008 at 4:05 pm
[...] Now here we are in September, counting down the days until we get to cast our votes for the next president. David from Health Business Blog has written an article comparing how the health care proposals from McCain and Obama handle requirements to obtain coverage. McCain is opposed to the idea of mandating coverage or requiring employers to provide coverage. No surprises there – he’s a believer in the free market when it comes to health insurance and health care. I’m just not sure how well that’s working out for families who can’t afford $280,000 earrings. (As an aside, what Cindy McCain wears is pretty far down on the list of things that matter to me. If she chooses to spend her money on designer clothes and jewelery, that’s her business. But when the median home price in America is less than what her earrings supposedly cost, it does make one wonder whether John McCain can truly grasp what it is like to have to choose between paying for private health insurance and paying for food). [...]
September 23rd, 2008 at 6:04 pm
Mc Cain plans to pay for any expansion by taxing the employer participation of currently insured people. I assume that means the employee will pay, as it would put a huge strain on my hospital if they paid. It appears that he plans to give the bill to the already stressed middle class and the lower paid workers, leaning most heavily on the less well paid. (The employer pays the same amount for everyone.)In my work place that means the housekeepers, clerical staff and ancillary staff. Oh, well, retirement postponed even further.
September 27th, 2008 at 9:50 am
My only problem with the kid’s only plan is that when an infectious disease in involved )in my county, TB is at fairly high levels for example) the parents who lack health insurance keep infecting their covered kids. So you can provide medical care only up to a point. We will eventually have to make sure that everyone has access to care.