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  • 'Expand and Economize' vs 'Redeploy and Devolve'

    As part of their Health Care Watch series, The New York Times Campaign Stops blog invited Heritage vice president for domestic policy Stuart Butler to analyze the presidential candidates health care plans. Butler writes:

    Barack Obama’s approach might be called “expand and economize.” Essentially he would add commitments and centralize, and then try to offset costs with new revenue and efficiency improvements. He would widen coverage by launching new programs and expansions of existing ones, plus requirements on many businesses to increase worker coverage or pay a tax. He seeks to pay for most of this in two ways, both of which are problematic, technically as well as politically. And he envisions detailed national requirements and arrangements for benefits and insurance.

    Mr. Obama says that part of this can be paid for by “rolling back” some of the Bush tax cuts. But the Congressional Budget Office will remind him that those cuts sunset in 2010, leaving him with a financing problem that might require him to abandon his proposed middle-class tax cuts. The other source of financing is the hope that improved technology and greater efficiency will yield far more savings than can realistically be expected.

    John McCain’s approach to the problem might be called “redeploy and devolve.”Rather than add major new spending on top of existing spending and tax subsidies, he would cap the tax break for employer-sponsored coverage and use that tax revenue to finance a subsidy for less affluent people to pay for coverage. Sounds like the kind of tax increase that reasonable progressives like Ezekiel Emanuel should support. Interestingly, Mr. Obama’s economic adviser Jason Furman wrote a more radical version of such as tax subsidy redeployment earlier this year. (You can link to a preliminary draft here.) So whoever wins, this piece of the McCain proposal might get an honest airing and bipartisan support.

    Mr. McCain also takes the view that it is unwise and a tough political challenge to try to structure a national system mainly at the federal level. I agree with him that it would be more practical to set outcome goals for coverage at the federal level and then press states to put forward ways they could achieve those goals, giving them some flexibility to propose creative approaches. By allowing for a degree of diversity toward a common purpose, this approach would be more likely to garner bipartisan and state support than a proposal for a more standardized national system.

    Posted in Obamacare [slideshow_deploy]

    4 Responses to 'Expand and Economize' vs 'Redeploy and Devolve'

    1. NH speaks out says:

      I agree with McCain personally. I don't want to give more power to the Government. It would give us more choices in Healthcare with McCain's approach. I have been without healthcare in the past based on my own choices yet was never turned down for basic healthcare or emergency services. I was always given the opportunity to pay small payments per month($15.00)to pay off the bill. If someone has not experienced this they need to contact their state offices.

      I also through budget analysis discovered it was more cost effective for me to cover my own medical expenses annually and just have catastrophic insurance coverage.

      A few years ago I lived in Canada for a couple months and everytime they found out I was an American they felt free to express their concerns about their socialized healthcare. Most common ones were lack of good care, long waits (ex: 2 days) in Emergency rooms and extremely high tax burdens. I'll paraphrase by saying they made sure to tell me that they hoped stupid Americans wouldn't make such a mistake. But really they love us. In a nutshell I don't want the government to supply me healthcare insurance I want them to govern our country, protect our borders, help other countries that are oppressed, go after alternative fuels/transportation and make corporations accountable for actions such as the current Mortgage/Bail out issues. Last but not least protect our freedoms of choice and put the power back into the people. If we get tax breaks it puts $$ back into the people's pocket…not our government. That way we the people can spend, create and build our country. No plan is perfect but I believe McCain really does want American's to grow and be strong and self sufficient people.

    2. Valorie Sheehan says:

      Try dealing with a major health crisis without insurance. Medical proticol is often based upon medical insurance . You may be seen in an emergency room without insurance, but you won't get chemotherapy or physical therapy without it.

    3. John Parker, NH says:

      I agree that we have a healthcare problem that should be addressed. More government is not the answer.Let's look at why healthcare cost as much as it does, maybe the problem is with frivioulus lawsuits that the medical field has to insure for.

      Doctor's fees need to cover education expences, The price that hospitals charge for over the counter pills is way out of line.

      If "big insurance" is paying the bill, the average consumer does not care what the cost is.

      Here is an example of how national healthcare would work.

      The company that I work for, had a coffee pot in the break room, and the ones that drank coffee, paid $3.00 a month to cover the cost ,and they drank as much as they wanted. There was never a shortage of coffee.

      The company decided to bring in a new coffee machine, that would be free to all employees. At first, we ran out of coffee weekly, after about 2 months, they came up with the right supply.

      The company is spending more on coffee than we ever did with the old program.

      If it is free…..people will take advantage.

      This is exactly what would happen with healthcare.

    4. GrandDadBuzz, Chapel says:

      At the end of the day the American people need to wake up and understand that citizens have to pay for heath care. Here is a simple 6 Step Solution to the Health Care Problem:

      1. Do away with employer tax deductions for employee health care and replace it with a $2,000 tax credit for individuals with income below $150,000. Index the tax credit to inflation. The AMA supports getting employers out of health care too. http://www.ama-assn.org/ama1/pub/upload/mm/363/eh

      2. Replace Medicare , Medicaid , Indian Health Service, State Children's Health Insurance Program (SCHIP), Federal Employees Health Benefits Program and full coverage health insurance with a Federal Health Care Credit Card payment system. A credit card would be issued to all citizens. Credit card debt limits and minimum payments would be set based on the income and the net the assets of the card holder. Those below the poverty level would have very low payment requirements, the highest debt limits and the lowest interest rates applied to their credit card debt balance. Those with high income would have high minimum payment requirements, low debt limits and a high interest rate on the credit card balance. To keep demand in check everyone should be required to make a payment per month that they can afford. A minimum payment schedule would be updated annually. The credit card balance would be the first debt paid from the card holder's estate at the time of death. The card holder controls usage and provider selection.

      3. Require all health care providers to publish standardized quality metrics and a price list for all services offered.

      4. Require only one price for each service or package of services, no special deal pricing or price discrimination for anyone.

      5. Tort reform to limit awards and limit lawyer fees to reasonable amounts.

      6. Regulate insurance companies requiring them to only sell insurance to individuals and families and only sell at one price for each age group. Do not allow insurance companies access to medical records. Only allow insurance coverage with deductibles above $5,000 indexed to inflation. The individual would use the Federal Health Care Credit Card to pay premiums, would be required to submit claims directly to the insurance company (like car insurance), and the insurance Company would pay claims to the Federal Health Care Credit Card. This would get insurance companies out of the practicing of medicine.

      With this plan everyone would be covered and consumers would have an incentive to shop for the best value and only seek care when it is really necessary.

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