Policy & Practice

Central to John McCain's proposal to assist the uninsured involves rearranging the way the federal government treats healthcare benefits. Currently, all of the money spent by businesses on healthcare benefits is excepted from federal payroll and income taxes (Cannon, 2008). For the most part, those who do not receive employer- or government-provided healthcare do not presently receive any assistance whatsoever toward obtaining coverage. This system largely benefits effectively unionized, and middle and upper class employees whose employers can afford to make the benefits available to them. It is an inequitable system that, by all measures and accounts, is inadequate.

McCain wants to take a large step away from the predominately employer-based system and move toward something that includes a supplemental foundation in individualism. While retaining the tax incentives for employers currently in place, McCain's proposal provides direct financial assistance to individuals and families. Under his proposal, every American under age 65 will receive a $2,500 tax credit (essentially cash) to spend on health insurance through any number of venues (the average annual cost is approximately $3,025 (Health, 2008)), whether individually or through other group plans (i.e. churches, unions). Families may instead choose to receive a $5,000 credit to use toward family coverage. In either case, the money is sent directly to the insurer from the federal government so as to avoid misuse and fraud.

An independent economics-based assessment of the McCain proposal produced by the Health Systems Innovations Network, LLC (HSI) estimates that of the 47 million uninsured, 27.5 million will gain coverage; the proposal is expected to operate at an annual cost of $287 billion. Among those who will benefit most under McCain's proposal are: rural populations whose employers typically cannot afford the high costs of health care; those over the age of 50 and under the age of 65; and those below the 50th percentile of wage income who would see a 365% increase in coverage. McCain would cut the uninsured population by more than half (Impact of John McCain, 2008). This is accomplished through a number of specific programs, the most intriguing of which are profiled below:

This program is one of the moral hallmarks of the McCain proposal. Acknowledging that costlier patients may have trouble successfully navigating through the market to obtain insurance, McCain proposes a collaborative approach to insuring the low income and chronically ill; the approach places caps on the premiums insurers can charge and provides additional monetary assistance from taxes to those who still cannot afford coverage with the tax credit. He proposes a non-profit government-run organization for those who are denied coverage that spans across state boundaries so as to reduce overhead costs and make coverage more affordable. HSI estimates that this program alone will reduce the uninsured population by more than 2 million at a cost of $18.4 billion (Impact, 2008).

The individuals covered under this program undeniably comprise one of the most challenging populations public health and charitable enterprises seek to assist. This group faces exceedingly high premiums as their preexisting conditions virtually blacklist them from private insurance providers. To compound the problem, they have few resources, economic or otherwise, to obtain care for themselves. While this program itself does nothing to address the corresponding problems associated with their socioeconomic position (i.e. a lack of transportation, cultural and language barriers, an absence of health education and knowledge), it does make significant progress in terms of coverage.

Entire categories of vulnerable individuals whose insurance coverage situation is more precarious would benefit tremendously under the McCain plan. Those whose employers only pay a share of the premiums could use their credits to pay the remaining portions (Appleby, 2007). People who change jobs could have individual insurance so they would not lose coverage. Self-employed persons could use their tax credit to make obtaining coverage more affordable - though, admittedly, not guaranteed. McCain's tax credit would also address those individuals between the ages of 24-34 who make-up one of the largest uninsured populations, enabling them to access coverage at higher rates (Appleby, 2007). Millions of the Americans who fall into of the aforementioned categories - those who do not currently realize the full advantages of the employer-based coverage system - would have the potential to obtain benefits under the McCain proposal.

McCain's health care concerns extend beyond the basic conversation over insurance coverage. He has had a long-standing interest in community health centers. His proposal includes provisions to create an account to fund a Community Health Access Corps, which will aid him in his goal to work closely with leaders in low-income and minority communities to conduct more sensitive research and locate healthcare providers more conveniently in neighborhoods and retail centers. Clinical trials and sociomedical research will largely focus on minorities and how health care delivery could be tailored to their cultural and environmental realities. While lacking in specifics, it appears that McCain is aware of the well-established public health fact that all communities are unique and need a health care system tailored to their particular needs and environments (Kirby, 2008).

In recent years, funding for the National Institute of Health (NIH) decreased in both real and nominal terms. In the last five years alone, the NIH's research funds declined 12% (Lucier, 2008). Contrary to McCain's typical preference for budget cuts, he proposes a doubling of total NIH spending. This means an additional $29.5 billion per year would go toward research on a vast range of health issues affecting Americans (Federal Funding, 2008).

McCain's proposal pays special attention to the expansion of research on cancer (McCain, Straight Talk, 2008) and autism. McCain's NIH priorities emphasize studying those factors (biological or social) which contribute to the onset of these diseases and creating technologies that allow doctors to screen for them earlier and more accurately. He hopes to continue his attempts to hold federal hearings on these issues, and support increased funding to advance the efforts already being made (McCain, Combating Autism, 2008).

McCain also includes provisions to expand federally funded efforts to work with businesses and insurance companies to promote healthier eating habits, increased physical activity, and smoking cessation programs. Importantly, McCain plans to increase internships with the NIH, and provide financial incentives to encourage talented health professionals to work in rural and underprivileged areas (McCain, Straight Talk, 2008).

The mass pandemonium raised in the mainstream media regarding McCain's seemingly sound and comprehensive proposal is that the new tax credits are wildly insufficient because of the rising costs of insurance premiums; they fear the increased costs will render the amounts insufficient and consequently push millions more into the “uninsured” category (Kevin Sack, 2008). However, given the high priority of the cost containment proposals common to the Democratic and Republican platforms, this may not pose a problem (Impact of Barack Obama, 2008)(McCain, Straight Talk, 2008). Through increased competition across state boundaries, infrastructural developments favoring reduced overhead, and steps toward preventative care, costs may not continue to spiral out of control. Furthermore, the left-leaning Tax Policy Center estimates that the proposal would save the average American taxpayer $1,200.

Should it occur, however, it is quite simple in legislative terms to increase a tax credit. The U.S. Congress is more able to address a small tax issue than American employers are able to keep up with the increasingly burdensome premiums. Keeping with the heavy emphasis on employer-based benefits will undoubtedly lead to cuts in employee benefits. Additionally, the tax credit given to individuals and families is supplemental; all the tax incentives employers currently have for providing coverage would remain in place, identical to their current form.

Undoubtedly, McCain proposes a substantial shift in the way health care is provided to the American public. Through the use of a supplemental tax credit, given to individuals and families, McCain will provide coverage to millions of Americans who currently lack it, and relieve the financial burden of those whose employers only offer partial coverage. Paying special attention to the needs of high-risk individuals, minorities, and the poor, McCain's policy would make tremendous improvements in the areas of access and quality of care. The health of the nation stands to make considerable gains.

Cannon, M. F. (2008, October 3). Joe Biden's Health Care Whopper. Retrieved October 13, 2008, from CATO Institute: www.cato.org/pub_display.php?pub_id=9694

Federal Funding. (2008). Retrieved October 15, 2008, from Biophysical Society: www.biophysics.org/policyadvocacy/policyissues/federalfunding/tabid/446/default/aspx

Kirby, J. B. (2008). The Differential Effect of Community-Level Socioeconomic Disadvantage on Access to Health Care. American Sociological Association. Montreal.

Lucier, G. T. (2008). A Biotech Call to Arms. Retrieved 2008, from Biotech360: http://www.biotech360.com/biotechArticleDisplay.jsp?biotechArticleId=100013#