Barack Obama and John McCain on Healthcare Policy

Healthcare is a central issue in the presidential campaign.

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Few would disagree that the U. S. healthcare system is in trouble. People in America pay more for healthcare per capita than people in any other country in the world, yet by many measures the quality of the care is lacking. Some 46 million Americans are without health insurance, and another 25 million are underinsured. Meanwhile, costs keep rising: The premium for a family health insurance policy is $12,680, more than double what it was nine years ago, according to the Kaiser Family Foundation.

Turning point. As the economy has worsened and employers have continued to shift healthcare costs to their employees, more people at all income levels are feeling the pinch. Last year, 41 percent of working-age adults said they were either paying off medical debt or had problems paying their medical bills, up from 34 percent in 2005.

Where McCain stands. John McCain would end the income tax break that workers currently receive on their healthcare benefits. Instead, he would provide tax credits of up to $2,500 to individuals and $5,000 to families to buy coverage on their own. People who are denied coverage because of pre-existing medical conditions could buy insurance through federally supported Guaranteed Access Plans, with income-based financial assistance available.

Where Obama stands. Barack Obama's plan would require employers to offer health insurance or contribute a percentage of payroll to a public plan for those without access to employer insurance. Children would be required to have coverage under the Obama program, which would expand SCHIP and Medicaid. No one would be denied coverage because of a pre-existing condition.

Bottom line. McCain's plan would reduce the number of uninsured by 21.1 million by 2010 and cause a net increase in federal spending of $2.05 trillion between then and 2019, according to a new analysis by the Lewin Group, a healthcare consulting firm. Obama's plan would shrink the uninsured by 26.6 million and cost $1.17 trillion over the same time period, the analysis said.