WASHINGTON (ABP) — Differences in presidential candidates John McCain and Barack Obama’s plans for reforming the American health-care system reflect their 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.
One thing is certain: Like the industry they seek to reform, both of the major-party presidential candidates’ plans are massive and complex.
McCain’s plan focuses on using market forces to drive down health-care costs, thereby shrinking the number of Americans who do not have health insurance by several million. 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.
Kevin Schmiesing
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“Without question, there are two distinct approaches on display by McCain and Obama,” said Kevin Schmiesing, a research fellow with the Michigan-based Acton Institute, in an e-mail interview. The Michigan-based institute is a Christian “think tank” that generally favors free-market views of economic issues.
“To their credit, both 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. 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 non-covered 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 focuses more on a mixture of market reforms and government subsidies, aiming to reduce the number of uninsured Americans far more dramatically. It would expand the State Children’s Health Insurance Program (SCHIP) to increase the number of children from lower-middle-class families who would be eligible. He also would expand Medicaid.
Obama’s 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 that 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 health-care system, he asserted, 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 is what we naturally do in every other area of our lives. This can only be accomplished by returning responsibility for payment directly to the consumer — not routing it through a third party, be that an employer or a government. McCain’s plan moves us in this direction; therefore, I believe it to be the most economically realistic over the long term.”
But, critics of free-market approaches to the health-care crisis have argued, health care is not like other goods and services.
“The commodity-based approach to health care 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 health care 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 health care, 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 health care. But he said churches and other private organizations should embrace their role as healers to make up for the difference.
“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,” Schmiesing noted. “Some people on the margins of society will simply never be able to afford the level of health care 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 metropolitan areas. It aims its services at the working poor, and couples clinical care with programs that use faith communities as vehicles for encouraging better health practices among vulnerable populations.
“I think, No. 1, that people in the church and churches in general — and at a local level is what I’m talking about — have to care about these issues and see them as fundamentally issues of faith. Historically the church has done that,” Morris said.
“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. Health care in America is very expensive, and when people start figuring out who pays for all of this, that for me is when the rubber hits the road,” he said.
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Read more
Side-by-side comparison of McCain and Obama health-care proposals from the Kaiser Foundation
McCain campaign page on health-care proposal
Obama campaign page on health-care proposal