WASHINGTON (ABP) — Differences in presidential candidates John McCain's and Barack Obama's plans for reforming the American healthcare system reflect differing views on the proper role of government.
Whether one plan more closely resembles biblical principles of justice and charity than the other — or whether either will work at all — also may depend on how individual Christians view the proper role of government.
McCain's plan focuses on using market forces to drive down healthcare costs, thereby shrinking the number of Americans who do not have health insurance. Obama, by contrast, envisions a stronger government role in expanding access to health insurance for the working poor, as well as placing more responsibility on consumers, the insurance industry and employers alike for reforming the system.
“To their credit, both (McCain and Obama) recognize that no single element of reform is going to save the day; instead, the platform of each contains a number of reform proposals operating on a number of different fronts,” said Kevin Schmiesing, a research fellow with the Michigan-based Acton Institute, a conservative Christian think-tank. “Both recognize the need to control costs, to address the problem of the uninsured, and to improve the quality of delivery. Yet McCain's proposals, on the whole, are striving for a system characterized by more competition, more choice, and more freedom; while Obama's tend toward greater government intervention.”
McCain's plan would give an annual tax credit of $2,500 to individuals and $5,000 to families. The funds would go to purchase health insurance.
Any funds left over after insurance is purchased could be deposited in health-savings accounts to reimburse taxpayers for any deductibles or other noncovered health expenses. In addition, the plan would include the self-employed, who currently get no tax benefits when they purchase health insurance.
McCain's plan aims to reduce the costs of insurance plans with a number of incentives — such as allowing insurers to sell their products across state lines — that would increase competition and consumer choice.
Obama's plan would dramatically expand the State Children's Health Insurance Program to increase the numbers of children from lower-middle-class families who would be eligible, and it also would expand Medicaid.
His plan would allow people who are not insured by their employers but who make too much for SCHIP or Medicaid to participate in the same federally subsidized insurance program government workers use. It also would allow the self-employed and small businesses to participate in the plan.
Finally, Obama's plan would create a National Health Insurance Exchange for private insurers. Insurers participating in the exchange would have to meet certain standards for deductibles and services, could not turn away customers with pre-existing conditions and would be regulated in other ways by the government. Companies would have to disclose costs of procedures to consumers, and consumers would be able to compare the benefits of various plans participating in the exchange.
Schmiesing prefers McCain's plan because he distrusts government's ability to improve the situation through more subsidies and regulation. The core of the problem with the current healthcare system, he claimed, is that it is overused.
“People need to be encouraged to consume just the amount of healthcare they really need — or can personally afford — and not any more,” he said. “This can only be accomplished by returning responsibility for payment directly to the consumer — not routing it through a third-party.”
But, critics of free-market approaches to the healthcare crisis have argued, healthcare is not like other goods and services.
“The commodity-based approach to healthcare is fundamentally flawed,” says a position paper from the Human Right to Health Program, a coalition that advocates for universal healthcare as a human right.
“It restricts access to healthcare to those who can afford to buy it and assumes that prices will be reasonable because supply and demand are linked. With most products, consumers limit their demand based on price. But in the case of healthcare, demand is not price sensitive. When you are sick, you don't have a choice.”
Schmiesing acknowledged McCain's plan would leave significant gaps in the numbers of people who have access to affordable, high-quality healthcare. Chur-ches and other private organizations should make up the difference, he said.
“Where people cannot afford the health care they need, that is where other institutions — families, communities, churches, and sometimes government — will need to intervene,” he said. “It's no accident that many hospitals bear names reflecting their current or former religious affiliation. Some people on the margins of society will simply never be able to afford the level of healthcare that they need.”
Scott Morris agrees. Morris is a physician and United Methodist minister who founded the Church Health Center in Memphis, Tenn., in 1987. The ecumenical organization operates a clinic that serves about 36,000 patients a year in one of the nation's poorest major cities. It aims its services at the working poor and links clinical care to programs that use faith communities as vehicles for encouraging better health practices among vulnerable populations.
“This is fundamentally a theological idea. … So, the first step is to say that the body matters, that God breathed the breath of life and the spirit into a human body. As Christians, we believe in the resurrection of the body. Jesus, in our Eucharistic settings, it's all about a physical body and blood that we are partaking of, so first we've got to cross this line to say we care about that stuff.”
Churches, Morris continued, should take care of improving the health of their communities at a local level — by offering healthier congregational meals, for instance. “If you've got to have fried chicken to draw a crowd, there's something wrong with your message,” he said.
As for the candidates' plans, Morris said neither is realistic — nor likely to make it, intact, through Congress regardless which party is in charge.
“The politics of it is brutal, and poor people have very little power in this mix. And somebody has to foot the bill,” he said. “Healthcare in America is very expensive, and when people start figuring out who pays for all of this, that for me is where the rubber hits the road.”