Brownstein: The health care divide
McCain may be pushing for greater changes than the Democrats
By Ronald Brownstein
National Journal
Fri., May. 16, 2008
WASHINGTON - Countless details separate John McCain's health care proposal from those of the Democratic presidential contenders. But the most significant difference is fundamental and philosophical. The two sides are offering divergent visions about the basic role of health insurance in the nation's social safety net. The fork in the road could not be starker.
The plans unveiled by Barack Obama and Hillary Rodham Clinton encourage the sharing of risk between the healthy and the sick, even at the cost of requiring the former to subsidize the latter. McCain's proposal would maximize individual choice in obtaining coverage, even at the cost of reducing risk-sharing. This contrast, which reflects the broader divide between the Democratic emphasis on community and the Republican focus on personal freedom, is the wellspring from which all of the major differences in the candidates' plans flow.
Confused press coverage and McCain's shift to other issues have obscured the magnitude of his proposal. But he may be pushing for greater changes than the Democrats in both the way Americans pay for health insurance and how they buy it--changes that have potentially profound implications for the pooling of risk.
Today, if a company provides its workers with health coverage, it can write off the cost of those premiums as a business expense, just like salaries. But Washington doesn't tax the employee on the value of that benefit. That "exclusion" makes employer-provided coverage tax-free for workers and is a major reason that employers insure 60 percent of Americans. Just 9 percent of Americans purchase insurance as individuals. (The rest rely on government programs or are uninsured.)
(Continued here.)
By Ronald Brownstein
National Journal
Fri., May. 16, 2008
WASHINGTON - Countless details separate John McCain's health care proposal from those of the Democratic presidential contenders. But the most significant difference is fundamental and philosophical. The two sides are offering divergent visions about the basic role of health insurance in the nation's social safety net. The fork in the road could not be starker.
The plans unveiled by Barack Obama and Hillary Rodham Clinton encourage the sharing of risk between the healthy and the sick, even at the cost of requiring the former to subsidize the latter. McCain's proposal would maximize individual choice in obtaining coverage, even at the cost of reducing risk-sharing. This contrast, which reflects the broader divide between the Democratic emphasis on community and the Republican focus on personal freedom, is the wellspring from which all of the major differences in the candidates' plans flow.
Confused press coverage and McCain's shift to other issues have obscured the magnitude of his proposal. But he may be pushing for greater changes than the Democrats in both the way Americans pay for health insurance and how they buy it--changes that have potentially profound implications for the pooling of risk.
Today, if a company provides its workers with health coverage, it can write off the cost of those premiums as a business expense, just like salaries. But Washington doesn't tax the employee on the value of that benefit. That "exclusion" makes employer-provided coverage tax-free for workers and is a major reason that employers insure 60 percent of Americans. Just 9 percent of Americans purchase insurance as individuals. (The rest rely on government programs or are uninsured.)
(Continued here.)
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