An analysis of John McCain's health policy on the website of the journal Health Affairs concludes that it will cover few of the uninsured in the short run—perhaps a net gain of a million or so—and expand the overall number of uninsured Americans in the long run. And those who do have insurance, the authors conclude, can expect to pay more for less.

McCain would convert the current employer tax exclusion into a fixed dollar tax credit—$2,500 for an individual, $5,000 for a family, and it would not be inflation-adjusted. This means consumers would pay taxes on health benefits they get on the job, which are currently tax-free. They could use the credit to purchase insurance in the individual market, which the authors of the Health Affairs article described as "relatively unregulated" with higher administrative costs and fewer consumer protections. (We'd note that there are other bipartisan proponents of reducing or eliminating the tax break on employer-sponsored health insurance, which is regressive, but they want to use the money to cover the uninsured in a regulated insurance market with consumer protections.)

"Middle-range estimates suggest that initially this change will have little impact on the number of uninsured people, although within five years this number will likely grow as the value of the tax credit falls relative to rising health care costs. Moving toward a relatively unregulated nongroup market will tend to raise costs, reduce the generosity of benefits, and leave people with fewer consumer protections," wrote the four academic health experts, Thomas Buchmueller, Sherry A. Glied , Anne Royalty and Katherine Swartz.

They wrote that McCain's proposal would "radically transform" the U.S. health insurance, force people with chronic or acute illness to pay more out of pocket and eliminate state requirements that insurers cover services like cervical cancer screenings. They also found fault with his proposed pools for high-risk people, saying it would probably provide affordable coverage for fewer than 3 million people. Overall, within five years, they predict, the overall number of uninsured would be rising, and health security would be diminished.

A separate article on the web side by three other authors, Joe Antos, Gail Wilensky and Hanns Kuttner, criticizes Barack Obama's plan for failing to curtail rising health spending. The authors argue this raises "serious questions" about the fiscal sustainability of his program, which includes new subsidies for the uninsured, small businesses and other businesses with particularly high health expenses. The authors also say that Obama's proposal to offer individuals a choice of health plans through a national health insurance exchange would add a high regulatory burden on insurers, that could "lock in a higher cost structure and reduce the range of insurance options." In short, they argue that Obama—who has declined to back an individual mandate at this time until insurance costs are brought down—could end up driving up health care costs and making insurance unaffordable to even more families.

Interestingly, both of these articles included a section on how to improve the plans they've critiqued. This is the beginning of a dialogue that we hope will eventually take us to where we need to go: an effecient, high quality, health care system that covers us all.