BATTLE PLANS

John McCain and Barack Obama’s health reform plans are different both in their approaches to solving problems and their potential effects on voters. But to choose wisely, you have to do some homework. To help, we offer a guide to online resources that analyze how well the candidates’ proposals might work.

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The state of healthcare

The United States spent $2.1 trillion on healthcare in 2006, according to national health expenditure data from the Centers for Medicare and Medicaid Services. That number is expected to hit $4.3 trillion by the end of 2017 -- 19.5% of the gross domestic product.

The percentage of people with employer-based health insurance fell from 70% in 1987 to 59% in 2006, according to the National Coalition on Health Care.

Enrollment in high-deductible health plans with savings options rose from 5% in 2007 to 8% in 2008, according to the Employer Health Benefits 2008 Annual Survey.

More than 42 million U.S. residents, or 14% of the population, lack insurance, according to the most recent National Health Interview Survey.

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American mind-set

Healthcare ranks third among worries on the minds of registered voters, after the economy and Iraq, according to an October Kaiser Family Foundation poll. By party affiliation, it remains third among Democrats, but Republican voters put it at worry No. 6, after the economy, gas prices, Iraq, terrorism and taxes.

When people are asked how each presidential candidate’s proposed health reform plan will affect them personally, 40% say they don’t think one plan would be better for them than the other, according to an Oct. 1 poll taken by the Harvard School of Public Health and Harris Interactive.

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The analyses

The Commonwealth Fund, a nonprofit organization that supports independent research on healthcare, finds fundamental differences between the two plans. The organization has summarized the candidates’ positions in 22 areas, including prescription drugs, healthcare disparities, preventive medicine and chronic disease management. Go to www.commonwealthfund.org.

The Kaiser Family Foundation has several tools exploring McCain’s and Obama’s positions on health issues, including a side-by-side comparison of the candidates’ proposals to reduce the number of uninsured and deal with public programs like Medicare, their positions on taxing employees’ health benefits and their plans to pay for it all. The site also includes comparisons of the candidates’ positions on stem cell research, electronic medical records, medical malpractice, mental health parity, prescription drug costs, women’s health and veterans’ health. Go to www.health08.org.

The Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution, estimates that over 10 years, McCain’s plan would cost the federal budget $1.3 trillion, while Obama’s plan would cost $1.6 trillion. Go to www.taxpolicycenter.org.

Political scientist Jonathan Oberlander, associate professor of social medicine and health policy and administration at the University of North Carolina, Chapel Hill, offers an analysis of the candidates’ plans in the Aug. 21 New England Journal of Medicine, including a chart with key points. For this and other journal reports on the campaign, look for the “Election 2008” label at content.nejm.org.

WebMD, one-stop shopping for medical news, offers the information in relatively small bites. Look for the “Election 2008” label at www.webmd.com.

The public policy journal Health Affairs published a set of papers in September that included a critique of each candidate’s health plan, along with a paper by economist Mark Pauly of the Wharton School at the University of Pennsylvania suggesting possible areas of compromise. Look for the political party symbols at www.healthaffairs.org.

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And the criticism

Health policy advisors to Sens. Barack Obama and John McCain summed up the candidates’ criticism of their opponents’ plans in an Oct. 1 debate. Said Dr. Irwin Redlener, advisor to Obama: “The healthcare system is wacky and out of control. It can’t run amok. That’s what Wall Street did.” Said Dr. William Winkenwerder, speaking for McCain’s plan: “We’re spending $800 billion more for healthcare than we did just eight years ago. It’s scary when you think about it.” Click the “podcast” button at the bottom of www.virginia.edu.

Physicians for a National Health Program, a group that wants universal health coverage through a single-payer system, said in an open letter to both candidates that any reform plan that continues to depend on the private health insurance model is wasteful, drives up costs and won’t cover everyone. Go to www.pnhp.org.

The Cato Institute, a libertarian think tank, has concluded that Obama’s plan relies too heavily on government and that McCain’s plan, while not perfect, is better from a free-market perspective. Go to www.cato.org.

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(BEGIN TEXT OF INFOBOX)

John McCain would . . .

Eliminate current tax exclusion for employer-paid health insurance.

Provide refundable tax credits of $2,500 for individuals or $5,000 for families, for everyone who obtains private health insurance -- employed or not. If insurance costs less than the value of the credit, the remaining funds could be deposited in a health savings account.

Provide a variety of insurance choices, national and across state lines, that would not be dependent on a job.

Work with state governors to increase insurance pools for people uninsurable on the individual market.

Deregulate insurance markets, allowing insurers to sell across state lines. People could buy less costly, less comprehensive policies in states with fewer mandates.

Pass medical malpractice reform.

For his full plan, click “Issues” at www.johnmccain.com.

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Barack Obama would . . .

Require employers (some small businesses would be exempt or subsidized) to either offer health insurance to employees or pay a tax that would be used to help uninsured people get insurance.

Provide subsidies for low-income Americans to help them afford coverage.

Create a new national health plan, similar to Medicare, for the uninsured and small businesses.

Require that all children have health insurance.

Regulate private insurance plans to end risk-rating based on health status -- a system that can render people like cancer survivors or diabetes patients uninsurable.

Establish a federal reinsurance program to protect businesses against the costs of workers’ expensive medical episodes.

For his full plan, click “Issues” at www.barackobama.com.