The cost of this country's failure to make health care coverage more accessible and affordable can be found in every Florida household and in every community. Nearly a quarter of Floridians who are not elderly are uninsured. Families fortunate enough to have health insurance saw their premiums rise 31/2 times faster than their incomes between 2000 and 2007. The cost to companies providing health coverage also has risen dramatically, and so has the public expense of providing charity care in public hospitals across the state. Incremental steps are not a viable option, and both presidential candidates have made health care reform a priority. Sen. Barack Obama has the most ambitious proposal and would extend more health coverage to more Americans. The Illinois Democrat would require all children to be covered by health insurance. He would give large employers a choice: Offer meaningful coverage to workers or contribute a percentage of payroll to help pay for a new public program. Those choosing to provide coverage would be reimbursed for some costs of covering catastrophic illnesses.
For small businesses and individuals who cannot find coverage elsewhere, there would be a new public health plan. No one would be excluded because of pre-existing conditions. Obama also would expand Medicaid for the poor and the State Children's Health Insurance Program. Congress voted to expand that program last year, but President Bush vetoed the legislation.
Obama's plan is a reasonable hybrid of private coverage and the government intervention needed to move toward universal coverage. Do not believe the Republican scare tactics. The Democrat's plan is not socialized medicine; workers who have coverage would keep their existing private plans. It will not fine small businesses as McCain alleges; small businesses would be exempt from the requirement to help pay for the public plan if they did not offer coverage.
Actually, it is McCain's warmed-over market approach that would damage the existing system rather than improve it. He would eliminate the tax exemption on the portion of the cost of health coverage paid by the employer. Then he would provide a refundable tax credit of $2,500 for individuals and $5,000 for families who could opt to offset the new tax on the employer-provided coverage, or purchase health insurance on their own. Market-driven solutions are not going to work, and changing tax policy to promote health coverage would do more harm than good.
McCain's plan likely would result in more employers dropping health coverage and more workers shopping for plans that would be priced out of their league even with the tax credit. Independent groups such as the Commonwealth Fund concluded it would insure only 2-million more Americans. In a country with more than 45-million uninsured, that is too little bang for too many bucks.
The Arizona Republican's plan would cost $1.3-trillion. Obama's proposal would cost $1.6-trillion and cover an additional 34-million uninsured. Obama's plan would be partially paid for by letting tax cuts for the wealthy expire. McCain is counting on saving money by reducing costs in Medicare and Medicaid.
Both candidates support improving health care information technology and pushing for more preventive care to reduce costs. Given the economic crisis and the ballooning deficit, there is no guarantee that either approach to health care reform will be immediately carried out as the candidates envision.
But to make significant progress on one of the country's biggest issues, there has to be a commitment to significant change. Obama offers the most creative approach, blending public and private efforts to substantially reduce the number of uninsured.
This is the first in a series of five editorials on issues voters must consider before heading to the polls.
To read the Times' full recommendations for the Nov. 4 election, visit tampabay.com/opinion.
This is the first in a series of editorials on key issues in the 2008 presidential election.
To read the Times' full recommendations on all amendments and races for the Nov. 4 election, visit tampabay.com/opinion.