Published 23 September 2008, doi:10.1136/bmj.a1672
Cite this as: BMJ 2008;337:a1672

Feature

US health care

Health and the US presidential campaigns

¹ Washington, DC 20037, USA

Feature, doi:10.1136/bmj.a1563

The ways Americans get insurance, the costs they bear, and their access to health care will all be affected by the plans of the presidential candidates. Barbara Markham Smith describes the implications of the two proposals

The first 150 words of the full text of this article appear below.

John McCain and Barack Obama offer two very different visions of the healthcare future.^{1 2} While neither moves to a single payer system that provides automatic universal coverage, there is a substantial spectrum between single payer and the current predicament in America.

Americans who have employment based insurance receive a substantial tax subsidy since the dollar value of their insurance benefits is not counted as taxable income. There are also other benefits. Employers buy their insurance in group markets, which are not only cheaper but do not subject individual employees to medical underwriting—discrimination through higher prices and exclusions from coverage based on actual or predicted medical needs. Therefore, people with employer based insurance have better access to insurance. In addition, the group policies generally offer more substantial benefits than individual policies. Often, employer plans have lower initial out of pocket costs, more preventive benefits, and better protection against catastrophic costs.

Americans . . . [Full text of this article]

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