The 2008 Presidential Candidates' Health Reform Proposals: Choices For America

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The 2008 Presidential Candidates' Health Reform Proposals: Choices For America

October 2, 2008 | Volume 100

Authors: Sara R. Collins,Ph.D., Jennifer L. Nicholson, Sheila D. Rustgi, and Karen Davis, Ph.D.
Contact: src@cmwf.org
Editor(s): Martha Hostetter




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Which Proposal Holds the Greatest Promise?

To evaluate the candidates' proposals, the Commonwealth Fund Commission on a High Performance Health System identified several key principles for moving the health system toward high performance. They include:

* provision of equitable and comprehensive insurance for all;
* provision of benefits that cover essential services with appropriate financial protection;
* premiums, deductibles, and out-of-pocket costs are affordable relative to family income;
* health risks are broadly pooled;
* the proposals should be simple to administer, with coverage that is automatic and continuous;
* dislocation should be kept to a minimum—people could choose to keep the coverage they have; and
* financing should be adequate, fair, and shared across stakeholders.

Measured against these broad principles, Obama's proposal for mixed private–public group insurance with a shared responsibility for financing has greater potential to move the health care system toward high performance than does McCain's proposal to encourage individual market coverage through the use of tax incentives and deregulation (Figure ES-4). Compared with McCain's approach, Obama's approach could provide more people with affordable health insurance that covers essential services, achieve greater equity in access to care, realize efficiencies and cost savings in the provision of coverage and delivery of care, and redirect incentives to improve quality. In the absence of a requirement that everyone has affordable coverage, however, the proposal is likely to fall short of achieving universal coverage.