Health Care and Politics I – The Republicans

No matter which side of the political fence you sit on, most Americans agree that our health care system is broken. Health care costs in the United States are approximately 16% of our gross domestic product (GDP), and they are expected to reach 20% of the GDP by 2017. That amounts to a staggering $4.3 trillion! Costs are clearly out of control, yet 47 million Americans remain uninsured.

Health care reform is an important issue of the 2008 Presidential election, and both Republicans and Democrats are proposing radical changes that will change the face of health care delivery in this country. Both sides of the political aisle aim to make health care more affordable and control escalating costs. Both Republicans and Democrats also plan for employers having a smaller role in medical benefits. The differences in how each side wants to achieve these goals are striking, however.

John McCainThe Republican plan, lead by Presidential nominee Senator John McCain, creates a national insurance market that gives consumers more power and choice than we currently have. McCain plans on eliminating the tax break given to employees if their employer provides health care. This tax exclusion dates back to the 1940’s and originally allowed employers to compete for workers by offering tax-free benefits instead of higher salaries. This also allowed employers to provide better benefit packages than employees could buy with their own after-tax dollars.

Under McCain’s plan, benefits would be taxed as income, generating nearly $3.6 trillion in government revenue over 10 years. However, he proposes a $2500 tax rebate for individuals, $5000 for families, to compensate for the increased tax burden. This is a more equitable allocation of resources, as each American — employed or unemployed — receives the same tax rebate under the new plan, while the tax exclusion now in place is based on the employee’s tax bracket. On the other hand, while employees would now be able to buy the same benefit packages as employers, the incentive for employers to provide coverage would come to an end. Some experts believe that under McCain’s plan, employers would stop paying for heath care within 3 to 4 years.

Without employer-provided coverage, individuals could choose a plan that better meets their needs, age, health status, and stage of life. McCain’s plan deregulates insurance markets and encourages competition. He would allow people to purchase insurance plans across state lines, enabling us to shop for lower-cost, more comprehensive plans that suit each person or family’s needs.

John McCain also plans to change the way Medicare receives payment for services. Rather than fee-for-service reimbursement, he proposes payment for episodes of care, and payments based on outcomes. These changes would encourage broader reform in the health care system and promote accountability among health care providers.

Further, John McCain plans to speed up generic drug development, encourage prevention in health care and the management of chronic diseases, adopt malpractice reform, and enhance the use of health information technology. However, under McCain’s plan, most uninsured Americans would remain uninsured. The high prices of health insurance, even with a tax rebate, may be unaffordable to low-income workers, especially if employers discontinue providing benefits. To improve access to coverage, McCain proposes a “guaranteed access plan” to create insurance alternatives for people still unable to afford or obtain health care. Currently, 34 states operate similar plans for medically uninsurable residents. Sadly, these plans encounter high costs, limited benefits, and exclusions for pre-existing conditions and offer no real relief from commercial insurance plans.

The Republican’s health care reform package is far from perfect, but is an interesting comment on the Republican’s view of free markets. This plan aims to treat health care as a resource, not an entitlement, and encourage nationwide competition. The Republicans believe that an important step in controlling health care costs is to treat Americans, not just as patients, but also as consumers.

In health care and politics: The Democrats, we will examine the health care reform plan of Barack Obama and the Democrats.


J. Oberlander (2007). Presidential Politics and the Resurgence of Health Care Reform New England Journal of Medicine, 357 (21), 2101-2104 DOI: 10.1056/NEJMp078202

J. Oberlander (2008). The Partisan Divide — The McCain and Obama Plans for U.S. Health Care Reform New England Journal of Medicine, 359 (8), 781-784 DOI: 10.1056/NEJMp0804659

R. Steinbrook (2007). Election 2008 — Campaign Contributions, Lobbying, and the U.S. Health Sector New England Journal of Medicine, 357 (8), 736-739 DOI: 10.1056/NEJMp078151

  • Alois Ballweber

    .Who is really paying health insurance aka desease care in America.
    Folks lets check the facts and do the math and you will find it is us the taxpayer paying 100% of it all.
    1. The “Private Sector” as the republicans so fondly call it is “Providing” health insurance but it is us the taxpayer after paying taxes on our wages and purchase the goods and services from those businesses who “Provide” health insurance. Providing employees with health insurance is a business expense and it is build into the price of those goods and services we buy and is also tax deductable and it gives those companies who refuse providing health insurance an unfare advantage because they charge somewhat lower prices and yet reap a higher profit margin.
    2. There are about 14 million federal employees with health insurance paid for by ,yes you guessed right,the taxpayer and the same goes for our city, county and state employees of about 45 million people.
    3.Those unfortunate people who have no health insurance due to unemployment or who have jobs with companies that use predatory employment practices and other factors cannot afford seeing doctors as needed and will and do end up in the emergency rooms of our hospitals that are again paid for by the taxpayer.
    4. Medicaid paid for by the taxpayer.
    Well, having said all that i think a redistribution of this existing wealth should suffice to include every man, woman and child.

  • Mary Bagwell

    Let’s think about John McCain’s plan from the prospective of a lower income individual. If your take home pay after taxes is between$300-$500 a week and you have rent or a mortgage, transportation costs, food and perhaps child care to pay where do you get the $1000 or more a month to buy private insurance? A tax credit is very nice if you have a high income but it will not help you afford payments like this. He has also not addressed those with preexisting conditions who cannot get coverage at any costs.

    Case in point. My granddaughter lost her insurance during a pregnancy and could not even get a doctor to see her even though she could have paid. Thus she received no pre natal care and her baby was born with pneumonia and spent many days in NICU. The taxpayers paid this bill as in the meantime her husband had lost his job and the hospital had to put her on emergency medicaid. The current health care system in the country makes no sense at all and the McCain plan would only make matters worse.

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  • sam

    Your health is a commodity…
    Police, fire-safety, roads, education (rudimentary),…. these are all OUR responsibility… but your health is the elitist’s profit. Disgusting… how do the republicans associate themselves with religion (pro-life), when they condone the most unchristian industry since slavery?

    Just another facet of the unrestrained greed which is causing our economy’s legs to buckle under it’s own bloated belly.

    It’s all down to greed, and it makes me sick… where’s a doctor when you need one?

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Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.

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