At the heart of the debate over health care are the philosophical underpinnings that determine where the responsibility for health care should lie. Obama's plan is a much more government centered plan that relies on regulation and government mandates to deliver health insurance. According to Meckler, Obama "would create a new government-run plan as well as an "exchange" in which private companies would offer insurance to compete with the government plan". This would mandate complete coverage for all children, expand the SCHIP program, and bring in many millions of adults under government funded private insurance as well as Medicaide (Bivens and Gould). Each of these actions amounts to increased regulation and extends government control over the health insurance industry (Meckler). However, this increased government involvement would assure a greater number of people are covered under the Obama plan as contrasted to the McCain plan.
McCain's plan relies on market coverage and reduces the current dependence that workers have on company provided insurance. McCain's plan would drop the tax exemption for company paid health insurance and replace it with a direct tax credit. According to the Brookings Institute "Senator McCain has proposed replacing the current exclusion from income tax for health insurance provided by an employer with a refundable tax credit of $2,500 for singles and $5,000 for family coverage" (7). According to Bivens and Gould, "This change sets off a cascade of decision-making by firms and employees, the net effect of which would be to erode some of the incentives that employers and employees have to tie health care benefits to job-based compensation and encourage health care purchase through the individual market. It would also provide incentives for people to buy less comprehensive insurance coverage". The net long-term effect of the McCain plan is less coverage with little savings over the Obama plan.
A much larger percentage of the uninsured would be covered under the Obama plan. According to the Economic Policy Institute, "The Obama plan makes a much bigger dent in covering the uninsured population. On average over the 10-year period, the Obama plan covers over 47% of the forecasted uninsured population, while the McCain plan covers less than 5%" (Bivens and Gould). The McCain plan simply encourages employers to drop their employees and give them a small tax credit and this would initially result is a dramatic drop in the rate of employer carried insurance. "A study conducted by University of Michigan economist Tom Buchmueller and colleagues published in the journal Health Affairs suggests that the McCain tax hike will lead employers to drop coverage for over 20 million Americans" (Cutler, DeLong, and Marciarille). In addition, McCain's plan allows for individuals to purchase health insurance out-of-state, which would effectively remove much of the current state regulation in the industry.
While Obama's plan will cover almost 10 times as many of the existing uninsured as the McCain plan, the costs of both plans are not dramatically different over the long-term. Meckler reports on a report released by the Tax Policy Center and states, "Sen. Obama's plan would be costly, the center concluded: $1.6 trillion over 10 years. Sen. McCain's would cost nearly as much: $1.3 trillion over the same span. The center doesn't give either campaign credit for initiatives to