STEVE INSKEEP, host:
It's Morning Edition from NPR News. I'm Steve Inskeep. The financial crisis has not yet forced the presidential candidates to change many of their promises. And let's look at one. We're continuing our close look at the presidential candidates' plans to change the US health system. Yesterday, we heard some details of John McCain's plan. Today, let's look at Barack Obama's claim that he can make health insurance available to all Americans and make health care cheaper. It's a promise that few health care experts think Obama can keep. NPR's Julie Rovner reports.
JULIE ROVNER: It's become a familiar number to those who've listened to Obama talk about his health plan on the campaign trail this year.
Senator BARACK OBAMA (Democrat, Illinois, Presidential Nominee): And we'll cut the cost of a typical family's health care by up to $2500 per year.
ROVNER: He's got a long list of ways he says he'll do that.
Senator OBAMA: By investing in prevention, and stopping diseases before they get so bad that they're expensive to treat. By investing in a paperless system to cut administrative costs. And by covering every single American and making sure they can take their health care with them if they lose their job.
ROVNER: Actually, Obama's plan wouldn't cover every single American, though it is estimated to reach about 34 million of the estimated 46 million uninsured. But setting that aside, most health economists say that while the kind of cost cutting he's talking about is a good thing, it's...
Dr. JOE ANTOS (American Enterprise Institute): Not anywhere near enough and not anywhere soon enough.
ROVNER: Joe Antos is a health economist with the conservative American Enterprise Institute.
Dr. ANTOS: We've been talking about these ideas for 10 years, 20 years, and we are still looking for the answer in so many of these areas.
ROVNER: Antos says the biggest problem with Obama's health plan isn't how little it will save but how much it will spend. One of Senator Obama's key promises is that under his plan, everyone will be able to get a health plan at least as good as those available to members of Congress.
Dr. ANTOS: Well, if your Congressman is like your average federal employee, he's got the Blue Cross standard option that costs in excess of $12,000 a year. That isn't going to happen. It can't happen.
ROVNER: That's because such a generous benefit package, combined with Obama's promise to limit out-of-pocket health costs, would require enormous public subsidies, Antos says. The Obama campaign itself estimates the plan could add as much as $60 billion a year to the nation's $2 trillion health tab.
Dr. ANTOS: We could be talking about 10, 15, 20, $25,000 of subsidy for an average low-income family that is required to put in, through premiums and through out-of-pocket expenses, fifteen hundred dollars or $2,000.
ROVNER: Still, Harvard economist David Cutler, who helped craft Obama's health plan, defends its costs cutting proposals.
Dr. DAVID CUTLER (Harvard University): Senator Obama has put forward the most comprehensive proposal to do this of anyone who's ever run for president.
ROVNER: Obama would get another source of financing for his plan from money currently going to tax cuts for upper-income people. Cutler says he knows the plan will be expensive and he doesn't apologize for it.
Dr. CUTLER: Many of the Republicans believe that what we ought to have is a very, very bare bones package, something with a several thousand dollar deductible that maybe doesn't cover prescription drugs or doesn't cover preventive services. To me that's just a non-starter.
ROVNER: Cutler says it makes no sense for people to have a health insurance policy that they can't afford to use until they get very sick. John McCain has also made health care cost cutting a key goal of his health care plan. But his lists of cost-cutting tools looks a lot like Obama's. Health policy analyst Jeff Goldsmith says both candidates are tiptoeing around the cost issue and he's not surprised by that, Given what happened the last time a president tried to overhaul the health system 14 years ago.
Dr. JEFF GOLDSMITH (University of Virginia): I think after the debacle of the Clinton reforms the prudent strategy for a presidential candidate at the stage of race is to pander but do not wake the dragon.
ROVNER: That dragon being doctors, hospitals, and other providers of health care.
Dr. GOLDSMITH: You're talking about rearranging the food supply for a two and a half trillion dollar animal, that's how big our health care system is. And do you really want to give it a year to organize to stop you from taking it's food away? That's basically what we're talking about here.
ROVNER: Of course, given what else is going on with the economy, that's assuming either candidate is able to make health reform a top priority next year or even get to it at all. Julie Rovner, NPR News, Washington.
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