MADELEINE BRAND, host: This is Day to Day. I'm Madeleine Brand.
ALEX CHADWICK, host:
I'm Alex Chadwick and we're continuing our series looking at the big issues of the presidential campaign. Today, we're going to focus on the candidates' health care plans.
BRAND: And for help, we turn to Trudy Lieberman. She is the director of the Health and Medicine Reporting Program at the City University of New York's Graduate School of Journalism. She's an expert in health care policy, and I began by asking her to describe John McCain's central healthcare philosophy.
Ms. TRUDY LIEBERMAN (Director, Health and Medicine Reporting Program, City University of New York): He has two main ideas. One is that he would offer every family a tax credit for $5,000 and every individual a credit for $2,500. And people are supposed to use this tax credit to go into what we call the individual market. That's a marketplace where people who don't have any kind of government-provided insurance or insurance from their employer have to go to buy their policies.
BRAND: Let me just stop you there and ask you about the numbers. He's proposing $5,000 for family of four tax credit, but from what I understand, the average cost for a family of four, for health care plan is $12,000.
Ms. LIEBERMAN: That's correct. This $5,000 credit is static, it doesn't grow over time. And we all know what's happened to health care cost, we all know what's happened to insurance premiums, they go up. So, when this $12,000 premium hits say 14,000 or 15,000 down the road, the credit is still worth $5,000, so it buys even less.
BRAND: So does John McCain think that most people will stay with their employer-sponsored plan and then just use this $5,000 tax credit to add on to it?
Ms. LIEBERMAN: No. I think that they think that people are going to leave their employer's plan and the way they plan to get people to move out of their employer's plan is to start taxing the value of the health insurance benefit that people get from their employer. So what this means is that people, particularly low-income people, who don't have a lot of money to spare are going to find that they're going to dig pretty deep in their pockets to come up with this added income tax that they're going to have to pay on their employer-provided plan.
BRAND: OK. So that's that cornerstone of the McCain plan. Let's turn to Senator Obama's plan and what is he proposing?
Ms. LIEBERMAN: I think we can say that there are really two key aspects of Obama's plan. One is that he would expand Medicaid and the State Children's Health Insurance Plan, which was a program set up by Congress about a decade ago. The second part is something that's a little bit nebulous right now and that's called his public option. He's not quite sure how this will work or how it will actually emerge in any kind of legislative process. But the gist of it is that people would be able to buy insurance from this public plan, and he often says that people would be able to buy the same kind of insurance that members of Congress have. It's not clear whether the insurance provided for the so-called public option will be provided by private carriers or whether it will be a Medicare-like program. In that particular program, the government provides the benefits.
BRAND: So could anyone opt into this public plan? It sounds like a good deal.
Ms. LIEBERMAN: Well, it's not clear who will be eligible for it. Early in the campaign the boiler point language on his Web site said that people would be eligible for it who did not have a public plan, in other words, they were not covered under Medicaid, SCHIP or Medicare, or that did not have employer-sponsored coverage. So I think it's one of those details that's not going to be clear until there's actually legislation passed.
BRAND: It sounds like both plans are very complicated and there are lots of details to still be worked out. We still don't know how many of the uninsured each plan would cover or indeed, how much each plan would cost. Neither plan does achieve universal health care coverage, so why is it that these two plans are so complicated and so confusing?
Ms. LIEBERMAN: I think we have to think a little bit about what the U.S. healthcare system is like. It's really like no other system in the developed world. We rely on private commercial insurance companies to provide the coverage. Systems in other countries rely on the government to provide the benefits, very similar to the way our Medicare program works. What the insurance companies do in this country is they exist to make money and they make money by basically insuring healthy people. They select the people that they want to cover. In other words, we want to insure people who aren't going to be sick. That's counterintuitive because most of the time, you think that, geez, when you're sick is when you really need insurance and that's when the insurance systems in the other countries come into play. But in our system, in particular markets, that's not the way it works. When you're sick, you're likely to lose coverage.
BRAND: Well, doesn't Senator Obama's plan forbid insurance companies from doing that, from denying people who have pre-existing conditions?
Ms. LIEBERMAN: He says that he would like to do that. He wants to require insurance companies to take everybody. I think that that's going to be one of the big flash points in the legislative process over the next couple of years because again, the insurance companies make money by denying claims and choosing the healthiest people to insure. And the minute you take that away from them or try to take that away from them, it's going to mean that they're going to fight.
BRAND: Trudy, as you mentioned, health care costs are just going through the roof every year. They're increasing higher and higher, aren't we going to have a discussion about rationing and care? About denying care to people?
Ms. LIEBERMAN: I don't want to call it rationing. I think there are two things to think about here. One, the cost control measure that both McCain and Obama have proposed are pretty minimal. In fact, one blogger calls them cost-containment light, and I think I would agree with that. They're not really going to do very much toward denting this $2.7 trillion healthcare bill that we have. So what's really needed here, and that other countries do much better than we do on this, is that they kind of limit some of the technology. That's not to say they don't use the technology or the same things we do.
In England, for example, girls don't get Pap smears until they're 25. When I look at the Canadian system, MRIs are not routinely done for sports injuries. In this country, we do ration care. We ration to people who don't have health insurance, which is pretty much people at the low end of the economic ladder. In order to really get a handle on the cost, that conversation has to take place. And neither candidate has been leading us in that direction.
BRAND: Trudy Lieberman is the director of the Health and Medicine Reporting Program at the City University of New York's Graduate School of Journalism. Thank you very much.
Ms. LIEBERMAN: Thank you.
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