The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher risk individuals, he said.
But Dr. Jack Lewin, CEO of the American College of Cardiology, said maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is its potential to destabilize the existing employer-based coverage system, he said. While in the long-term it might be a good idea to move away from that system, it should be a gradual process, he said.
Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system but doesn't define how it would be done, he said.
Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute.
However, that murkiness may be appropriate since members of Congress will be the ones to refine the details of any health care reforms, he said. “He clearly intends to engage and work with Congress and stakeholders.”
And Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. The debate over SCHIP has started the conversation about the need for universal coverage and at the same time a majority of Americans are worried about the affordability of health insurance, he said. “There's a different environment,” Mr. Nichols said.
Sen. Barack Obama estimates that, if implemented, his plan would save the average family about $2,500/year.