The presidential hopefuls – Republican John McCain and Democrat Barack Obama – surprisingly agree on health reforms, but only to the extent that the current healthcare system is not working. They both opine the country needs to reduce the ranks of the 46 million uninsured and provide alternatives to job-based insurance. 

Other than this basic aspect, there are no more similarities between the proposals of the two candidates. McCain wants to allow people to buy health insurance across state lines, while Obama, opposing the idea, appears to believe it would create an unsafe, unregulated health-insurance market.

According to McCain’s proposal of reform, the private market needs to be relied upon to heal the ailing system. He proposes tax breaks enjoyed by employers for subsidizing health insurance should be eliminated. This he feels can thereby help in treating the benefit as a taxable wage, and offering tax credits to facilitate the policies to be bought in the open market. 

In Obama’s opinion, the reforms should be built on the current system, requiring employers to provide meaningful coverage to a new public plan. The plan, unlike a pure single-payer or government-run one, would give people guaranteed access to a mix of both plans with benefits similar to those available to federal workers.

To put both the proposals in simple terms - McCain values individual control and competitive market forces, Obama values expanding government and private insurance. 

As far as the costs involved in the plans is concerned, the Tax Policy Center, a project of the Brookings Institution and Urban Institute, estimates that the tax-related provisions of McCain’s plan would cost $1.3 trillion over a ten year period, Obama’s plan could cost $1.6 trillion over the same period. 

Commenting on the two proposals, Drew Altman, president and chief executive of the Kaiser Family Foundation in Menlo Park, said that while McCain seeks to control costs by encouraging a more bare-bones approach that relies on individual choices about health spending, Obama views insurance as comprehensive health coverage. Drew added: “They have fundamentally different opinions of what insurance should do.”