Forget the economy, forget Russia, forget even Fannie and Freddie. If you're looking for your first full-time job, or you're between employers, or if you work now for a small company that offers no health plan, your main concern might be how to get health insurance.
Would you prefer a $5,000 tax credit toward buying a family health insurance policy and more competition among insurance providers (McCain), or a national public health care plan and additional regulation of insurance markets (Obama)? Do these plans raise or lower your taxes?
To the extent that voters decide on issues as well as party and personality, how Americans react to these two proposals could affect who wins the election.
Senator McCain's plan would cost less than Senator Obama's and would raise fewer taxes. Yet it is Mr. McCain's plan that is being demonized as a tax increase. In speeches last week in Pennsylvania, Senator Biden, Mr. Obama's choice for vice president, repeatedly said that Mr. McCain's health care plan would amount to a tax increase — without mentioning the new tax credit.
Here's what the two plans would do.
Mr. McCain would give Americans refundable tax credits of $2,500 per individual, $5,000 per family, to buy health insurance. He would pay for this by changing the current tax status of employer-provided insurance, and including employer-paid health premiums in workers' taxable income. The proposed tax credit would wipe out the new tax liability for nearly every worker.
Workers in the 25% tax bracket pay an extra $5,000 in tax on an additional $20,000 of income. So a $5,000 credit would offset the federal tax on employer-paid premiums up to $20,000 — and an average plan only costs $12,000 per year, according to the bipartisan National Coalition on Health Care.
The tax credit would also be available for individuals — employed, self-employed, unemployed — who buy health coverage independently, although not to seniors on Medicare. People with pre-existing conditions who could not get health insurance would be insured through new state Guaranteed Access Plans.
With the tax advantage shifting to individuals from employers, people would not have to worry about losing their insurance when they change jobs — just as they aren't concerned about losing their auto or home insurance.
The tax credit would be "refundable," meaning that it would go to people who don't owe tax. If it exceeded the cost of a plan, the individual would get the difference credited to a Health Savings Account, whose balances could be used to pay for insurance premiums and other health care costs.
The McCain plan would knock down state-line barriers to private health insurance plans and expand Health Savings Accounts. The combination of tax credits, nationwide insurance, and savings accounts would lead to increased competition among insurance companies, potentially driving down premiums.
Some people in upper income tax brackets with generous employer health plans would find that the new tax credit does not offset the tax liability — the extra tax they owe from including employer-paid premiums in their income.
But this would be a relatively small group. Under Senator McCain's plan, families whose marginal tax rate is 40% or less would see a tax decrease. Since the top federal rate is 35%, families would pay 40% only because of state taxes.
Senator Obama would set up a new health insurance plan, similar to the Federal Employees Health Benefits Program. It would be open to all, with "affordable" premiums and co-payments.
In addition, he proposes a new National Health Insurance Exchange to regulate private insurance underwriters by "creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible." Those who could not meet the standards would close.
Private insurance plans would have to offer coverage as generous as the public plans, including "preventative, maternity, and mental health care."
In a third Obama provision, some employers who offer health insurance now would have to pay higher premiums in order to raise benefits to the level of the new public plan. Those employers who don't offer health insurance would be required to pay into the new plan. These obligatory payments can be described in one word — taxes.
Mr. Obama estimates the cost of his plan at between $50 billion and $60 billion, including prospective cost-saving ideas, which he plans to pay for through higher income taxes on those making more than $250,000.
This estimate is clearly unrealistic. The insurance program for federal employees is of a higher quality and more costly than typical private-sector coverage. Extending it to allow 300 million Americans to participate would likely cost far more than $60 billion and need additional sources of revenue.
Americans know that health insurance needs to change to be easily accessible and portable, like auto and home insurance. Do we get there through higher taxes and regulation, or by tax incentives and individual choice?
Ms. Furchtgott-Roth, [email protected], former chief economist at the U.S. Department of Labor, is a senior fellow at the Hudson Institute.