Barack Obama on Health Care

WebMD asked Sen. Obama some questions about his health care plan. Below are his answers.

[Editor's note: The answers below were either provided by the senator or sanctioned by him. These are the opinions of the Obama campaign only. Though edited for WebMD style, the answers remain untouched. WebMD does not endorse any specific political party, candidate, committee, idea or belief.]

1. What is the core principle of your health care plan?

On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Joe Biden and I believe both of these extremes are wrong, and that's why we've proposed a plan that provides affordable, accessible health care options for all, makes insurance companies accountable, and ensures patient choice of doctor and care without government interference.

I believe that by ensuring all Americans have access to affordable and quality care that focuses on improving health outcomes, we will be able to reduce health care costs and ensure that America remains the most productive nation in the world.

2. Your plan is estimated to cost $60-$100 billion a year. In light of recent economic upheavals in this country, the war, and more, is it realistic to think you could get funding for this plan (especially if Congress doesn't overturn Pres. Bush's tax cuts)?

One of the things that I have said from the start of this campaign is that we have a moral commitment as well as an economic imperative to do something about the health care crisis that so many families are facing.

My health care plan is fully paid for by helping reduce wasteful costs in our health care system, including ending wasteful subsidies in the Medicare Advantage program and allowing Medicare to negotiate for prescription drugs, and ending the Bush tax cuts for the wealthy.

After enacting reforms to reduce federal health care spending, my plan will cost $65 billion per year, which will be fully paid for by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.

I believe that it is entirely realistic that Congress will work to fully fund this plan because the economic costs of continuing to let our health care costs spiral out of control are simply too high for American families and American businesses.

3. How will you encourage people to buy health care without a mandate, especially the so-called "young invincibles?"

My plan will expand the number of easy, attractive options for young adults to get coverage. I will create new tax credits for health insurance coverage for those Americans who cannot afford health insurance on their own, which will help younger workers who often make less than the average worker.

I will allow young people up to age 25 to continue coverage through their parents' plans, providing an easy, affordable option for young adults to retain portable health insurance as they switch jobs and attend college and graduate school.

And by allowing all Americans access to new easy-to-enroll portable health care options, I believe young workers will finally have the information and health insurance options that they lack today that will allow them to become insured.

4. What is the main distinction between your plan and Sen. McCain's?

Joe Biden and I have proposed a comprehensive plan to reduce health care costs for American families and ensure that all Americans have access to quality, affordable, and portable health insurance.

In contrast, John McCain has blocked efforts to expand access to health insurance and reduce health care costs. Instead he has proposed the same failed Bush approach to reform health care. With his health care proposal, John McCain has advocated tearing down our employer-based health care system, which will leave insurance companies in charge with little oversight or attention to improving Americans' health and mean higher taxes for American working families over time.

John McCain's radical transformation of the insurance industry will throw 20 million Americans from their current health insurance plans to a deregulated individual market, provide an inadequate tax credit to pay for quality health insurance coverage, raise administrative costs up to $20 billion per year, and do almost nothing to reduce the number of uninsured Americans.

By recycling George W. Bush's failed health care policies, John McCain is guaranteeing another four years of record cost increases and insurance industry profits while more and more Americans lose their health insurance because of skyrocketing prices.

5. How would you handle spiraling health care costs?

My plan invests in eliminating waste in our health care system, expanding coverage to all Americans to reduce the cost of uncompensated care, and picking up the cost of some high-cost cases from employers. Health care experts have projected that my strategic investments and reforms will save businesses $140 billion per year in premiums and $2,500 for the typical American family.

Specifically, my plan will:

• Increase health IT [information technology] investment, which will reduce unnecessary and wasteful spending in the health care system;
• Provide reinsurance for catastrophic cases, which will stabilize if not decrease insurance premiums;
• Improve prevention and management of chronic conditions;
• Increase insurance industry competition and reduce the abusive practices of monopoly insurance and drug companies; and
• Ensure every American has health coverage, which will lower spending on the "uncompensated" care of uninsured people who end up in emergency rooms, where their care is needlessly expensive and paid for by Americans with health insurance through higher premiums.

6. How important is prevention to your plan?

Covering the uninsured and modernizing America's health care system are urgent priorities, but they are not enough.

We believe that protecting and promoting health and wellness in this nation is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce, and federal and state and local governments. All parties must do their part, as well as collaborate with one another, to create the conditions and opportunities that will allow and encourage Americans to adopt healthy lifestyles.

My plan will promote public health by requiring coverage of preventive services, including cancer screenings, and increasing state and local preparedness for terrorist attacks and natural disasters.

7. How does your plan address pre-existing conditions or people with chronic health conditions?

I will require insurance companies to cover pre-existing conditions so all Americans, regardless of their health status or history, can get comprehensive benefits at fair and stable premiums.

8. How big a role do you see the Internet and technology playing in health care in the future?

One of the ways my plan will improve efficiency and lower costs in the health care system is by adopting state-of-the-art health information technology systems. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims.

My plan will invest $10 billion a year over the next five years to move the U.S. health care system to a broad adoption of standards-based electronic health information systems, including electronic health records.

We will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. We will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas.

We will ensure that patients' privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors' offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.

SOURCE: Sen. Barack Obama campaign.

WebMD does not endorse any specific political party, candidate, committee, idea, or belief.

John McCain on Health Care

WebMD asked Sen. McCain some questions about his health care plan. Below are his answers.

[Editor's note: The answers below were either provided by the senator or sanctioned by him. These are the opinions of the McCain campaign only. Though edited for WebMD style, the answers remain untouched. WebMD does not endorse any specific political party, candidate, committee, idea, or belief.]


1. What is the core principle of your health care plan?

Access to quality and affordable coverage for every American. The McCain plan builds on the existing employer-sponsored system to enable families to choose the plan that best meets their needs. Under the current system, Americans receive a tax benefit for health insurance only if they receive it through their employers.

Those who do not receive coverage from their employers or who have left the workforce are out of luck. Not only does our current health care system shut millions out of the system, but it also stifles the competition that can reduce costs and improve quality.

The McCain plan will give the same tax benefit to those who get health insurance in the individual market as those who get it through their employer. This will enable Americans to fire their insurance companies if they are unhappy with their plans and seek out a better option, including those across state lines.

The McCain plan will focus on reducing costs through reforms like reorienting the system around preventive care and wellness, implementing payment reform to reward quality and coordinated care, better managing chronic care diseases, investing in health IT [information technology], and finally enacting comprehensive medical liability reform.


2. After what just happened on Wall Street, do you think people will be willing to forgo their employer-based insurance, an option in your plan, and instead rely on the open market for their health insurance?

The McCain health plan builds on the employer-based system. Employers will have the same incentive to provide health insurance as they do today since they will continue to deduct the cost of health insurance they provide to employees. Nothing will change.

In addition, payroll taxes will be protected from taxes under the McCain plan. Millions of American families with employer-sponsored coverage in all tax brackets with the same coverage as a "member of Congress" will now come out ahead with additional funds going into a portable health savings account. Importantly, younger and healthier employees with the McCain health care tax credit will have a bigger incentive to stay with the employers.

For example, a 25-year-old employee in the 25% tax bracket with a $2,500 tax credit could either purchase a policy in the individual market for the same amount or stay with his employer plan and receive a $5,000 policy with an additional $1,250 to invest in a portable health savings account. Why would people choose less benefits and less money?

Finally, the McCain plan, through comprehensive cost-containment policies, addresses the single biggest threat to employer coverage -- rising costs.

What's more, those millions of Americans who currently do not receive health benefits from their employers -- and therefore also receive no benefit from the federal government -- will receive $5,000 per family to purchase health insurance, and they will have a wide range of choices because the McCain plan enables them to purchase health insurance across state lines.

Recent abuses by Wall Street bankers and Washington insiders are no reason to abandon the commonsense principle that putting choice and options in the hands of the American people can improve the quality and affordability of health care.


3. Your plan would offer a $2,500 tax credit for individuals and $5,000 for families. If people choose to shop for their own insurance, would this be enough to cover their costs?

Currently, those Americans who do not receive insurance through their employers receive no benefit from the government at all, unless they qualify for Medicaid. Under John McCain's plan, they will receive $5,000 per family to purchase health insurance.

A recent national survey found that when people purchase health insurance on their own, the average policy costs $2,613 for singles or $5,799 for a family. With millions more people in the market for insurance and demanding a fair price, including across state lines, insurance will be much more affordable and the credit will be a big help to them in obtaining coverage.

Furthermore, the comprehensive cost-containment measures included in the McCain plan will reduce health care costs for every American.


4. What is the main distinction between your plan and Sen. Obama's?

John McCain's plan relies on individual choice, including keeping current coverage, to bring down the cost of health care and to enable all American families to receive the same tax benefits; Sen. Obama's plan stifles individual choice with the aim of eventually funneling every American into European-style government-run health insurance.

Sen. Obama's proposal would dismantle the current employer-based framework in favor of a big new government bureaucracy. Obama would mandate that employers provide a $12,000 plan to their employees or else pay a fine. According to a study in the National Bureau of Economic Research, an employer mandate of $9,000 for family coverage would reduce wages by $3 per hour and cause 224,000 workers to lose their jobs.

To put this in perspective, the Obama plan would lose more than the 219,000 jobs created by American small businesses so far this year. The Obama plan would also build a $243 billion-a-year government-run health plan, shifting more control to lobbyist-filled Washington at a time when Medicare is broke and Congress has a single-digit approval rating. According to a recent analysis, the Obama employer mandate would raise employer taxes by nearly $226 billion.

The McCain plan is different. John McCain recognizes that the main problem plaguing our health care system is spiraling costs, which is why his plan is focused on lowering costs and expanding affordability for all Americans. He recognizes that when Americans are given the choice and ability to choose their own health care plans, costs go down and quality goes up.


5. How would you handle spiraling health care costs?

The main reason that the great majority of the uninsured don't have health insurance is because it costs too much. We need to work to get competitive forces moving in our health care economy, but we also need to level the playing field so everyone gets a fair break in purchasing coverage.

John McCain would provide a refundable tax credit of $2,500 for individuals and $5,000 for families that they would get every year to use toward the purchase of insurance. The credit is refundable, which means you would get the full amount even if you owe less in taxes. And it's available to you whether you get your health insurance at work, as the great majority of people will continue to do, or whether you buy insurance on your own or through new groups.

Further, the value of that credit will be enhanced by the greater competition this reform would help create among insurance companies. When coupled with reforms to spur innovation and flexibility in insurance options, millions more Americans will have the opportunity to buy affordable health insurance that is portable and secure.

The McCain plan will take numerous steps to make health insurance more affordable by reducing costs, including: permitting families to purchase health insurance across state lines; lowering drug prices through reimportation and generics; reorienting our health care system around preventive care; updating our health care infrastructure with 21st century technology; promoting coordinated care; reforming the Medicare and Medicaid payment systems; promoting the availability of smoking-cessation programs; passing comprehensive medical-liability reform; and bringing more transparency to health care costs.


6. How important is prevention to your plan?

The real key to lowering costs is to change the way medicine is practiced in America -- moving away from uncoordinated fee-for-service medicine that focuses too much on doing things to people and toward coordinated care that focuses on prevention and paying for quality outcomes. By rewarding quality, promoting prevention, and developing new models that deliver health care more efficiently and effectively, we can reduce health care costs for all Americans.

Wise public-private partnership can make preventive care the standard. It can put the best practices of preventive care in action all across our health care system. Over time, high standards of care, consistently applied in every doctor's office, hospital, and insurance company in America, will save lives. And every year, it will save billions in the health care economy, making medical care better and medical coverage more affordable for every citizen in this country.

Prevention and maintenance should be encouraged as part of basic insurance so that when individuals are shopping with their tax credit for health coverage, they are able to find an affordable plan that offers access to important preventable measures.

Wellness plans should be encouraged to reward and encourage healthy behavior. Plans should be allowed greater flexibility for providing financial rewards, including reduced premiums for healthy lifestyle behavior as well as surcharges for individuals who continue to elect unhealthy lifestyle behaviors such as smoking.

It is imperative that we use educational tools and proven strategies to affect the behavior early in the lives of children. The challenge of childhood obesity is very serious. And there are many things that schools can and are doing to create a healthier environment for our children. Current strategies include removing vending machines, providing healthy, low-fat menus in school cafeterias, and providing more physical education and recess opportunities for children.

However, each school has unique needs and challenges relating to the general physical health of students. Decisions about addressing childhood obesity should be made at the local level to ensure they reflect the needs of local schools and communities.


7. You've heard the question before I'm sure -- Many plans likely would not accept you with your pre-existing conditions, or be very expensive. How would your plan address pre-existing conditions, or people with chronic health conditions?

John McCain believes that no American should be denied coverage simply because of a pre-existing condition. As president, he will create a new nonprofit "Guaranteed Access Plan," or GAP, to help those who have trouble getting insurance. McCain will provide new funding and guidance for the states to create GAP plans that will allow people who are currently denied coverage to buy policies at affordable prices.

This would not be another unfunded mandate to the states or a new federal entitlement program, but rather a partnership between the federal government, the states, insurers, patients, and the medical community.

Indeed, a recent analysis indicated that over $500 billion in annual savings to state and local governments would be realized through the McCain health plan. Much of this can be attributed to savings to state Medicaid programs that would otherwise absorb medical costs by the population the GAP plan is designed to cover.

Under a McCain plan there would be reasonable limits on premiums and additional assistance would be available to help people with lower incomes. Furthermore, there will be a review process in place to determine if the decision by the insurer to deny coverage was improper.


8. How big a role do you see the Internet and technology playing in health care in the future?

John McCain sees technology as a key to reducing costs and transforming our health care system. We can make tremendous improvements in the cost of treatment by using modern information technologies to collect information on practice patterns, costs, and outcomes. By simply documenting and disseminating information on "best practices," we can eliminate costly medical practices that do not yield value and reward those that do.

A better and smarter use of information technologies will lead to increased quality, better coordination, reduced errors, and lower costs. By reforming payment systems to focus on paying for best practice and quality outcomes, we will accelerate this important change.

SOURCE: Sen. John McCain campaign.

The content contained in WebMD's "Health Matters in the 2008 Election" section is for informational purposes only. WebMD does not endorse any specific political party, candidate, committee, idea, or belief.

Time for Answers

The questions are in!

Thank you all for contributing to our effort to raise health care questions for the presidential town hall debate.

The response was outstanding. The questions were across-the-board intelligent and heartfelt, and once again reinforced how important health care is to this election.

Although we have stopped accepting questions for the town hall debate, please continue to keep this vital conversation alive on our Voice Your Vote election message board.

The questions you have asked over the past two weeks will now be put into the hands of moderator Ton Brokaw for his consideration.

And you can continue to ask questions at MyDebates.org.

Now, please tune in on Tuesday, October 7 at 9 p.m. ET/6 p.m. PT to see if your questions get asked -- and answered. I hope they do.

And you can continue to count on our coverage of health issues in this election at our special report, "Health Matters in the 2008 Election."

Regards,

Sean Swint
Executive Editor, WebMD

Ask the Presidential Candidates!

Do you have a health care question for Senators McCain and Obama?

Health care is a critical issue in this election and WebMD is proud to collaborate with the Commission on Presidential Debates to gather your questions for the second of three presidential debates, which will be held in a town hall format, and also include -- for the first time -- questions posted on the Internet.

You can do this one of two ways: Comment on this blog with your question. No sign-in is required, simply click on the "post a comment" link at the bottom of the page and enter your question.

Or submit your questions on our election message board. Please be aware you will need to register -- a quick process -- to participate in the discussion thread on the message board, or use your current sign-in if already a WebMD member.

We will gather all the questions and get them into the hands of debate moderator Tom Brokaw.

Then, watch the debate on Oct. 7 at 9 p.m. ET/ 6 p.m. PT to see if your question is answered!

You can go to our election special, "Health Matters in the 2008 Election," for more answers about the candidates' policies. You can also go to MyDebates.org for more information about the debates.

This is an important election for the future of health care. Please take the time to participate by asking a question.

Thank you.

Sean Swint
Executive Editor, WebMD

Palin is McCain's Pick

McCain's VP Pick is a dark horse if ever there was one.

Sen. John McCain has chosen Alaska's governor, Sarah Palin, as his running mate.

Virtually unknown on the national stage, Palin is Alaska's first woman governor, and was sworn in to the job in 2006.

The 44-year-old is known as a reformer, and holds a very high approval rating in Alaska.

The mother of five children, one of them has Down syndrome. She was aware of the situation before giving birth, but went ahead, saying she "sees perfection" in her son.

This aligns with her strong anti-abortion stance.

Although we will get more information on her health care stances in the day's ahead, she has been a proponent as governor for more affordable health care, starting with more flexibility in government regulations to achieve it.

Palin also wants more transparency in medical care, allowing patients to have more access to full medical billing information.

She had promoted a bill in her state called the Alaska Health Care Transparency Act to give consumers more info on quality, costs and other matters, stating that this type of transparency would raise competition and help lower health care costs in her state, which has a high number of uninsured people. Reportedly the bill has yet to make it through the legislature.

As said, we will have a more complete profile on Gov. Palin, and her positions on health care, in the coming days.

Stay posted.

Sean Swint
Executive Editor, WebMD

Obama Chooses Biden for VP

Sen. Barack Obama has chosen Sen. Joe Biden to be his running mate. Obama made the announcement Saturday on his website and in a text message to supporters.

The veteran senator, of Delaware, had made a bid for the presidency but dropped out in January after a poor showing in the Iowa caucus.

As a candidate, Biden's positions on health care were closely aligned with Obama's.

He offered an extensive plan to help achieve universal health care coverage. Among the plans he proposed were expanding the State Children's Health Insurance Program to age 21 and lowering the age for Medicare eligibility to 55. He supports stem cell research and abortion rights.

On a personal note, Biden, 65, suffered two aneurysms in 1988 that required surgery.

We will be bringing you more information about Biden in the coming days, as well as Sen. John McCain's vice presidential pick when he or she is announced.

Valarie Basheda
Managing Editor

Obama Clinches Nomination

After an exhaustive Democratic primary season, U.S. Sen. Barack Obama has inched across the line with enough delegates, despite losing some recent primaries to U.S. Sen.Hillary Clinton, to become the Democratic presidential presumptive nominee.

It is history in the making. For the first time an African-American will represent the Democrat party for the highest office in the land.

Sen. Clinton, in complimenting Obama on his well-fought race, said in her Tuesday night speech, "I will make no decisions tonight," refusing to concede her quest for the nomination. Multiple media sources are now saying Clinton may be holding out for the vice-presidential slot.

But Wednesday starts a new day for Obama. Even though he has been positioning his speeches recently against McCain's policies, he must now do it in earnest and in the open. As for McCain, he can now take the gloves off and run directly against Obama, not against an undefined candidate.

Nowhere is the difference between the two candidates more evident than their health care platforms. Sen. McCain is pledging a plan devised to cut costs, and to put many health care choices and decisions into individuals' hands.

Sen. Obama has pledged a platform that mandates health insurance for all children, and plans to offers options to insure all Americans, with government backing if necessary, for what he claims will be universal health care.

Each candidate, no doubt, will say they plan to eventually insure all Americans. Their paths to get there will likely take far different routes.

WebMD's election special, "Health Matters in the 2008 Election," will continue to cover the election until the last vote is cast. Soon, we'll have a new section titled "Reality Check." It will ask questions of non-partisan experts about each candidate's health plans, and how well they align with economic and political reality.

But any way you look at it, it's a historical moment in American politics.

Stay with WebMD for extensive coverage of one of the the most important topics in this election, health care.

We'll keep you posted.

Sean Swint
Executive Editor, WebMD