Let's talk about the substance of what these guys say they'll do for you - or to you. We've reported before about what's in Barack Obama's and John McCain's health care plans, and now we're going to examine the bottom line - how much those plans would cost or save.

NPR's Joanne Silberner has more.

JOANNE SILBERNER: The starting point is $2 trillion. That's what the U.S. spends each year on health care. Both Republican and Democratic plans are aiming at holding down costs and improving the quality of care. They do that through the existing private health insurance system. The idea is that with more customers, insurers will compete for business by offering good policies and finding ways to make care more efficient and thus cheaper.

Senator McCain's approach is to provide tax credits to help people buy health insurance. Douglas Holtz-Eakin is the Republican's economic adviser.

Mr. DOUGLAS HOLTZ-EAKIN (Republican Economic Adviser): It's going to be $5,000 toward every family's purchase of health insurance, something that would basically be a non-event for people who are already getting their insurance from their employer. But for those who are buying it out of pocket, a lot of help there.

SILBERNER: And he estimates that about 20 to 30 million people who don't have insurance now would buy it. Holtz-Eakin says that's all budget neutral from the government's point of view. The tax credit will be balanced by taxes on health insurance payments by employers.

A second part of McCain's plan is to help people who have a medical condition and can't find any insurers who will cover them at a reasonable price. Again, Holtz-Eakin...

Mr. HOLTZ-EAKIN (McCain Advisor): Our estimates are that that would cost about $20 billion, if you configured it along the lines of states like Minnesota that have been successful in reaching this population.

SILBERNER: Holtz-Eakin won't project the effect on the nation's health care bill. Obama's health advisor, David Cutler, says Obama's plan could cut spending 8%, though the savings could take several years. The Democrat's plan would require employers to contribute toward health insurance, a benefit that only half to two-thirds of workers now get. No one could be denied coverage.

Mr. DAVID CUTLER (Obama Advisor): What we estimate is that Senator Obama's health plan would reduce the cost of health care by about $2,500 for a typical family. That's a combination of direct out-of-pocket costs that the family no longer has to make, premium payments from employers that families are now paying for in their wages, in the lower wages that they receive.

SILBERNER: As well as less money paid out in taxes, as the government needs less money for its own health plans like Medicare and Medicaid. The candidates are looking to some of the same places for cost savings. They've talked about the availability of preventive care so that high cost medical conditions can be avoided, the promotion of less costly generic drugs, the development of health information technology to not only simplify billing, but prevent duplicate services and inform doctors about the best and most efficient care. Obama would even provide government support for that. But Princeton University health economist Uwe Reinhardt says the initiatives may help people, but there's not much evidence that they'll save money.

Mr. UWE REINHARDT (Princeton University): Most people actually don't believe preventive care will save money in the long run, but it will enhance the quality of life. You get more value for the dollar.

SILBERNER: The same for chronic care programs for conditions like diabetes or high blood pressure. Health information technology: horrendously expensive to put into place and maintain, he says. Generic drugs are already widely used. Both campaign officials say though that if you put everything together you will get a more efficient system. Meanwhile, polls are showing that interest in health reform, once high, is slacking off. Reinhardt says if nothing changes, we'll have more than health care to worry about.

Mr. REINHARDT: After 2025, if health care keeps growing like it has in the last 40 years, then there will actually be less money for education, less money for roads, for the military, less money for fashion, and everything else.

SILBERNER: If we get to that point, the problem will belong to another set of candidates.

Joanne Silberner, NPR News.


You can look more closely at the candidates' plans for health insurance and Medicare by going to's elections page.

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