McCain, Obama Advisers Debate Candidates’ Health Care Plans

Dr. Dora Hughes

Jay Khosla

Photographs © Scientists & Engineers for America

Six weeks before the U.S. presidential election, U.S. Senators John McCain and Barack Obama agree that the American health care system is ailing. But at a recent health policy forum, their campaign advisers sparred over the senators' voting records on children's health insurance, embryonic stem cell research, and government regulation, questioning each candidate's commitment to health care reform.

In often-pointed exchanges, Obama health policy adviser Dr. Dora Hughes and McCain adviser Jay Khosla answered audience questions about their candidates' plans reducing medical costs, covering the uninsured, and increasing the ranks of the health care workforce. While Khosla criticized the Obama plan for taking health care choice away from American families and giving it to "government bureaucrats and insurance companies," Hughes said the McCain plan would force people into "the highly dysfunctional individual market, where they are unlikely to get the coverage that they need."

The advisers spoke at an 18 September event in Washington, D.C., organized by Scientists and Engineers for America and co-sponsored by AAAS. AAAS and other science, health, and engineering groups have pressed the presidential candidates repeatedly to participate in a debate on science and technology issues, but both candidates have declined.

"The forum provided an opportunity for the research community to listen to candid remarks from senior advisers for both campaigns," said Joanne Padrón Carney, director of the AAAS Center for Science, Technology, and Congress. "The range of questions raised show the broad spectrum of science policy issues that the community is interested in."

The campaign surrogates spent much of the night debating the candidates' proposals to change the way Americans purchase health insurance, contrasting McCain's incentives to decouple coverage from employment with Obama's strategies to extend coverage to children and small business employees.

The centerpiece of McCain's health care plan is affordability, and rising costs are "the fundamental, underlying problem of what is wrong with the American health care system," said Khosla, who previously served as health policy counsel to Senator Bill Frist (R-Tenn.), the Senate's former majority leader. Khosla said McCain's plan would control costs in part through better management of chronic disease and Medicare reforms that link doctors' reimbursement to quality care.

The McCain health care plan would extend a $2,500 tax credit for individuals and $5,000 for families to help pay health insurance costs, while making insurance portable and not linked to employment. The plan calls for a national market for health insurance, where people could "go across state lines and buy insurance policies that best fit their needs," said Khosla.

Khosla also defended McCain's Guaranteed Access Plan, a partnership of insurers and states that would cover people with pre-existing medical conditions who are often denied or priced out of traditional coverage. He said the plan was not a "high-risk pool" that would limit the care choices of the chronically or severely ill.

Hughes questioned the usefulness of the proposed McCain tax credits, saying that they would not keep pace with medical inflation and would not be enough to cover most families' costs in an open market. "That's like giving someone in an eight-foot hole a three-foot rope," she remarked. "It's simply inadequate."

Hughes, a past deputy director for health for U.S. Senator Edward M. Kennedy (D-Mass.) on the Senate's Committee on Health, Education, Labor and Pensions, said the Obama plan would reduce the ranks of the uninsured. Under the Illinois senator's plan, all businesses would be required to provide health insurance to their employees or contribute to a new National Health Insurance Exchange that would help individuals purchase private insurance directly.

She disputed Khosla's contention that the requirement would drive some small businesses to cut jobs in a shaky economy. "If you have coverage through your employer that you like today, nothing will change," said Hughes. "If you're one of the 47 million uninsureds, you will have new options and new subsidies to assist you to provide you coverage."

Khosla declined to say whether McCain would lift the ban on federal funding for research on embryonic stem cell lines created after August 2001, but noted that McCain's "voting record is very, very clear in the Senate" in support of such research. Khosla did not answer a question about whether the Arizona senator, who has said that human rights begin "at the moment of conception," supports a ban on in vitro fertilization, which creates surplus embryos that may be frozen indefinitely or destroyed.

Hughes said Obama's support of embryonic stem cell research has been "clear and unwavering." Obama would not ban IVF, she said, adding that "he has advocated that the embryos that are resulting from IVF that are currently sitting in freezers across the nation should be... used in stem cell research" under certain conditions.

Both candidates would push for greater federal funding to build the American health and science workforce and improve the public health infrastructure, the advisers said. But Hughes and Khosla pointed to specific instances where voting records did not match campaign rhetoric. Hughes, in particular, singled out McCain's 2007 vote against expanding the State Children's Insurance Plan, and said McCain had voted "against increased funding for federal research at least 10 times over the last decade."

If elected, McCain would seek a freeze on all domestic discretionary spending, including science funding, in his first fiscal year budget, according to a 19 September report in ScienceNOW, the daily news service of Science magazine. Obama has said that he would double federal funding for basic research over the next decade.

The health advisers' debate was moderated by Julie Rovner, a health policy reporter for National Public Radio. Khosla and Hughes also answered questions about the use of a federal excise tax on tobacco to fund smoking cessation programs, the role of alternative medicine, and strategies to reduce health disparities among minorities.

Scientists and Engineers for America is a non-partisan, non-profit educational organization that seeks to support evidence-based decision-making in government. In addition to its focus on the 2008 elections, it is working to build a more engaged and politically active scientific community over the long term.

In addition to AAAS, the 18 September forum was co-sponsored by the American Institute of Biological Sciences; the Federation of American Societies for Experimental Biology; IEEE-USA; Research!America; the American Chemical Society; the American Society for Biochemistry and Molecular Biology; and The George Washington University School of Public Health and Health Services, including the Project on Scientific Knowledge and Public Policy and the Department of Health Policy.

Scientists and Engineers for America is organizing another presidential adviser debate, co-sponsored with AAAS, on energy policy at Stanford University.

Becky Ham

25 September 2008