Annals of Long Term Care

Democratic presidential candidate Barack Obama and GOP nominee John McCain both cite failings of the nation’s healthcare system—47 million Americans without healthcare coverage, skyrocketing healthcare costs, and quality gaps, among others.

But the two differ significantly in their proposals for addressing these problems. Exactly how politically and economically feasible their healthcare plans are is a matter of debate. That withstanding, here’s an overview of what the candidates have proposed concerning healthcare coverage, cost containment, quality, reporting, Medicare reform, care coordination, and other issues relevant to healthcare for older Americans:

Sen. John McCain

(R-Arizona)

Sen. McCain’s plan doesn’t call for a general overhaul of the nation’s healthcare system, but, rather, for limited, specific changes. He would not mandate universal healthcare coverage but would “use competition to improve the quality of health insurance with greater variety …lower prices and portability.” His plan would shift emphasis from employer-provided health insurance to privately purchased coverage. It would eliminate employer tax deductions for employee health insurance costs, and offer Americans tax credits ($2,500 a year for individuals; $5,000 for families) that they could use to purchase private coverage “tailored to their needs.” Sen. McCain would expand the use of health savings accounts and allow those choosing insurance that costs less than their healthcare tax credit to deposit the balance in these accounts. His plan would also allow Americans to buy insurance across state lines.

Under the McCain healthcare plan, Washington would work with states to create a federally supported “best practice model” Guaranteed Access Plan (GAP) for Americans who are denied coverage due to pre-existing conditions. GAP premiums would be limited, and low-income Americans would qualify for financial assistance with costs.

The healthcare platform the Republican Party unveiled during its September convention supports “balance” billing in Medicare, which would allow beneficiaries to add their own funds to government benefits. To supplement VA care, the senator would also allow veterans to seek treatment at private facilities, if necessary to get “timely and appropriate” care.

Sen. McCain supports linking physician and hospital compensation to performance—starting with Medicare and Medicaid. He would make reimbursement to those caring for beneficiaries dependent on outcomes. “Medicaid and Medicare should not pay for preventable medical errors or mismanagement,” the senator has said.

The McCain plan calls for the development of national standards for evaluating treatments. It would also provide consumers with more information concerning treatment options and physician performance, and “require transparency regarding medical outcomes, quality of care, costs, and prices.”

To cut Medicare drug costs, Sen. McCain has proposed that more affluent older adults pay more for Medicare prescription drug coverage than lower-income seniors. To lower drug expenditures he would encourage the “safe re-importation” of drugs and faster introduction of generics.

Sen. McCain’s healthcare plan calls for federal research into the prevention and treatment of chronic disease, which accounts for three-quarters of all healthcare spending. It also calls for public health initiatives to address rising rates of obesity and related chronic disease, and to deter smoking and provide mental health coverage. “By emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure and the use of information technology, we can reduce healthcare costs,” the senator argues.

The McCain plan would also place greater emphasis on coordinated care provided by teams of healthcare workers.