Experts say that Barack Obama or John McCain will find the going tough when they take office and try to push through healthcare reforms.
Democratic White House hopeful Obama is pushing for universal health care for all the nation's 300 million plus citizens, while Republican McCain is emphasizing the need for health care choice.
AdvertisementTheir goal however is the same - opening up health care to the largest possible number of Americans, improving the quality, and bringing down sky-high costs.
Their differences are ideological: for Obama access to affordable health care is a person's "right," while for McCain "it's a responsibility."
Obama's proposal involves a health care system partially financed by the state, while McCain's formula favors free-market competition among private insurance carriers that would lower prices.
"The main difference is the structure of the health insurance market," said Mahmud Hassan, an economist at Rutgers University in the state of New Jersey.
"The McCain plan focuses on the choice of the plan by the insured, focusing more on competition in the health insurance market," said Hassan.
Obama's plan, which centers around "managed competition," "would create a national health insurance exchange, much like a stock exchange, that would serve as a clearing house providing information to employers and individuals to evaluate different available plans for the insured," he said.
Obama has made it clear that health care reform is a personal issue for him.
"My mother died of ovarian cancer at the age or 53 and I'll never forget how she spent the final months of her life lying in a hospital bed, fighting with her insurance company because they claimed that her cancer was a pre-existing condition and didn't want to pay for treatment," he has said.
Obama said he would focus on ending all discrimination from private insurance companies, even when the patient has a pre-existing health condition.
While Obama's plan does not go as far as providing mandatory health care - as his Democratic primary rival Hillary Clinton has proposed - and while the system remains based on employers, the plan does call for mandatory health insurance for all children.
More than nine million children do not have health coverage in the United States, according to a recent study by the Journal of the American Medical Association (JAMA).
McCain discussed his proposed health care plan in the September/October issue, Contingencies, the magazine of the American Academy of Actuaries.
"Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation," McCain wrote.
McCain's plan focuses on taxes: families would get a 5,000 dollar tax credit that would go directly to the insurers. The plan would then tax consumers on the value of their employer-provided health coverage. Currently employees are not taxed for those benefits.
Under McCain's plan another 4.6 million people could thus obtain health insurance by 2013, with another 29.6 million under the Obama plan, according to the Brookings Institute think-tank.
"Putting more people in the system means expanding pressure on doctors and hospitals to deliver more care," said economist Jeff Rubin, also from Rutgers University.
"This might mean a need to expand the existing system," he said.
Health care reform will be an expensive proposition for whoever the next president is. McCain's version would cost some 1.3 billion dollars, while Obama's would cost some 1.6 billion dollars, according to Brookings.
And experts agree that a major reform has no chance of being approved in Congress early in the next president's first term. A recent study by the journal Lancet Oncology says the 700 billion dollar financial system bailout plan will shackle plans for all major government reforms.
"This will be the largest budget deficit in US history and will present an immense challenge for either plan," economist Roger Feldman from the University of Minnesota told the journal.
Feldman told the Lancet that one can expect health care reform that is "very incremental and around the edges" given the current economic chaos.
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