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Spending

Some Health Reform Answers

Monday, I said it was time for the candidates to get down to some real policy details and answer tough questions about their health care proposals.

Monday, I said it was time for the candidates to get down to some real policy details and answer tough questions about their health care proposals. Well, lo and behold ... while we don't get answers from John McCain or Barack Obama, we do get some good solid assessment of the plans and whether they will work from independent analysts.

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Health Affairs Journal had health care economists take a close look at both plans. The bad news is that they conclude there are huge failings in both -- McCain's plan would do nothing to cover the uninsured, and in fact the number of uninsured would likely grow after a few years; Obama's plan would get most of the uninsured covered, but do little to rein in rapidly escalating health care costs. "The Obama promise of affordability would require new, large, and rapidly growing federal subsidies that are unlikely to be sustainable, fiscally or politically," the authors of the critique of Obama's proposal said.

Don't expect McCain or Obama to make huge changes in their plans -- after all, proposals offered during a campaign aren't even a starting point for real legislation. They are more a marking out of general territory. But the candidates do need to address the toughest criticism and explain how much fiddling with their plans and approach they are willing to tolerate in order to pass legislation that has an honest shot at covering the uninsured and wrestling down costs. After all, a common trademark of both candidates is the promise to address problems pragmatically through bipartisan consensus.

A third article in the journal, by Mark Pauly, suggests that elements from both plans could be combined into an effective reform plan. "Admitting public plans as options and means-testing the tax credits would be a large change for McCain; paying credits that are the same whether insurance is individual or group would replace the Obama play-or-pay provisions," Pauly says. Is that medicine either candidate would take?

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