Sept 9 (Reuters) – Democratic presidential candidate Barack Obama and Republican candidate John McCain agree Americans spend too much on drugs and doctors and largely agree on what changes to make, but they have competing proposals to carry them out. Here is a summary of their positions:


McCain would end tax breaks for employer-provided health insurance and provide a refundable tax credit of $2,500 per person, or $5,000 for families. He would promote competition by allowing people to buy insurance across state lines.

Obama has proposed a national insurance program to allow individuals and small businesses to buy health care similar to that available to federal employees, supplemented in part by a tax on employers who do not provide coverage.

Both want insurance to be portable, meaning people would not lose coverage when they switch jobs.


McCain proposes a Guaranteed Access Plan or GAP provided by states. One example would be a nonprofit corporation that would contract with insurers.

Obama would create a National Health Insurance Exchange to help people buy private insurance, act as a watchdog and create standards. He would require health care for all children, and expand Medicaid and the State Children’s Health Insurance Program or SCHIP.


Both candidates support electronic health records to improve record-keeping and reduce errors. Obama would launch a federally backed system.

Both also support better coordination of care. Obama health advisers support the idea of a “medical home” — a primary care doctor who would help coordinate and oversee care.

Both candidates praise smoking cessation and weight-loss programs, especially those offered by employers.

Obama has studied the possibility of paying doctors to spend time with patients on preventing disease and rewarding them for better outcomes.


McCain wants to slow the double-digit growth that now makes health care spending 16 percent of the U.S. Gross Domestic Product.

Obama says he can reduce health care spending by 8 percent and save each taxpayer $2,500 with his ideas.

Both candidates support a plan to re-import drugs — meaning U.S. providers could buy them from countries that have negotiated lower prices with pharmaceutical companies. Both also support the wider development and use of generic drugs.

To lower costs for doctors, McCain proposes tort reform to reduce the number of lawsuits that doctors must insure against. Obama prefers to strengthen antitrust laws to lower insurance costs for doctors.

Both also encourage walk-in clinics at stores and elsewhere for routine health checks.

(Reporting by Maggie Fox, editing by Vicki Allen)