Health experts dislike proposals


POSTED: Thursday, October 16, 2008

Republican Sen. John McCain's health proposals would likely increase the number of uninsured, and Democratic Sen. Barack Obama's plan would cost much more than his campaign estimates, according to three University of Hawaii medical professors.





A look at the presidential candidates' health care proposals

        John McCain


$2,500 refundable tax credit for individuals, $5,000 for families, to make health insurance more affordable.


No mandate for universal coverage. Would no longer shield from income taxes those payments that businesses and their workers make toward employer-sponsored health insurance. Tax Policy Center estimates overall plan's cost at $1.3 trillion over 10 years.


  Barack Obama


Mandatory coverage for children, no mandate for adults. Aim for universal coverage by requiring larger employers to share costs of insuring workers and by offering coverage similar to that in plan for federal employees. Proposes spending $50 billion on information technology over five years to reduce health care costs over time. Tax Policy Center estimates overall plan's cost at $1.6 trillion over 10 years.



Drs. Stephen Kemble, assistant professor of medicine, V. Ted Leon, assistant professor of family practice, and Daniel Davis Jr., associate clinical professor of medicine, compared the plans in a telecast this week to the John A. Burns School of Medicine from the Queen's Conference Center.

McCain's plan “;turns out to be very bad for individuals,”; Kemble said.

It would provide tax credits to individuals and families for health insurance and eliminate a tax benefit for employer-sponsored insurance. Many predict this would prompt mainland employers to dump employee health insurance, Kemble said, questioning the effect on Hawaii's law mandating employer-sponsored health insurance for employees.

McCain proposes a refundable tax credit of up to $2,500 for an individual and $5,000 for families to buy health insurance. But the average family plan on the mainland is $12,000, and the Hawaii Medical Service Association's average family plan is $10,500, Kemble said.

Obama would provide universal coverage through a mix of private and expanded public insurance. He would require all children to have health insurance and employers to offer employee health benefits or contribute to the cost of a new public program.

He would create a National Health Insurance Exchange through which small businesses and individuals without access to other public programs or employer-based coverage could enroll in a new public plan or approved private plans.

Kemble said a big disadvantage of Obama's plan is the high cost, expected to surpass the $50 billion to $65 billion a year estimated by his campaign when fully implemented. He said Massachusetts has a similar plan, and it is costing the state more than expected.

Unenthusiastic about either candidate's plan, the UH professors offered some ideas of their own.

Leon, a member of the nonprofit Physicians for a National Health Program, said $2.1 trillion a year is spent on health care in the United States, yet 46 million people are uninsured.

He advocates passage of House Resolution 676 to provide an “;affordable single-payer national health insurance for all.”; The bill would create a publicly financed, privately delivered health-care system using the Medicare program and expanding and improving it to include all U.S. residents.

It would improve access to care, quality of care and cost control through a national health program, Leon said.

Davis said he is disappointed in McCain's plan and frightened by Obama's proposal because of the costs and potential problems such as those occurring with the government's Medicare program.

He favors a “;balanced choice proposal”; that would establish a national health-care financing system operated by a nonprofit trust with two levels of service such as offered for airplane travel.

A co-pay option would provide comprehensive health benefits similar to Medicare but include a pharmacy benefit and nursing home care. An independent option would pay a base amount to doctors, and patients would pay the gap between the base payment and charges. Patients and doctors would have a choice of plans for every problem.

The plan began in Boulder, Colo., and Colorado is considering it statewide to fix the state's health care system. Davis said it “;offers the best of both worlds,”; with universal coverage, cost savings, efficiency and incentives to stimulate quality care.

Kemble said he is proposing a resolution to the Hawaii Medical Association for a single-payer health care financing system with a national health board accountable for the system instead of Congress.