John McCain
Campaign website: http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm
Institute of Medicine health care reform principles necessary for the foundation of a just health care system (IOM 2004, http://www.iom.edu/CMS/3809/4660/17632.aspx):
1. Health care coverage should be universal.
Grade C: The McCain plan states "we can and must provide access to health care for all our citizens", however, it neither mandates that coverage nor does it prohibit private insurance plans from denying coverage. The plan calls for increasing insurance plan choices, increasing competition among insurance plans, income tax credits and the expansion of health savings accounts. The plan gets a C grade because, although it states that all citizens must be covered, it does not require guaranteed insurability by insurance plans, or individual or employer mandates that could make universal coverage achievable in a four-year timeframe. Additionally, it does not specify whether it will also cover undocumented persons and permanent residents.
2. Health care coverage should be continuous.
Grade B: The plan would enable families to purchase portable, multi-year insurance policies nationwide. These plans could be purchased from their employer, individually, churches, professional associations etc. The plan gets a B rather than an A because it doesn't describe how individuals insured through their employer would be continuously insured if they lost or changed their job.
3. Health care coverage should be affordable to individuals and families.
Grade F+: The McCain plan offers a $2500 tax credit to individuals ($5000 for families) to encourage the purchase of insurance. States will be required to provide a financial "risk adjustment" bonus to high-cost and low-income families to supplement tax credits and Medicaid funds. The plan receives a failing grade because it is likely, that for many families, the tax credit will not be sufficient to enable them to afford health insurance. Additionally, the plan is silent on the extent to which co-pays will impact individuals and families seeking care. *It should be noted, however, that the financial "risk adjustment" proposal is an innovative idea that may offer important protection to low-income families depending upon the specifics of implementation.
4. The health insurance strategy should be affordable and sustainable for society.
Grade C: The McCain plan would control costs by promoting competition throughout the health care system including between providers and among alternative treatments. Medicare would not pay for preventable errors but would pay for care coordination. The plan supports continued development of generic drugs and drug re-importation. The plan received a C because the cost-cutting mechanisms are unlikely to reduce administrative costs below 10% or increase the use of cost-effective services. The plan does not offer a vision for a well-integrated system of care.
Grade C: The McCain plan would facilitate the development of national standards for measuring and recording treatments and outcomes. Medicare compensation would be reformed to compensate providers for diagnosis, prevention and care coordination. The plan promotes preventive services, health information technology and telemedicine. It supports making more information about outcomes, quality of care, price and cost available to the patient. The plan would promote tort reform with the goal of limiting frivolous malpractice lawsuits. The plan received a C because it does not include a defined benefits package, it lacks specificity about how the quality of health care would be evaluated and the proposed malpractice reform would not enhance patient safety.
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