Sen. John McCain wants a deregulated, market-oriented approach that abandons tax incentives to businesses that offer health benefits, and would instead offer tax credits to individuals who purchase their own health insurance anywhere in the U.S. It is not clear that the tax credits offered would cover the cost of the average policy. Equally important, the regulation of health care is a state, not a federal issue. What happens when a resident in New Mexico has a reimbursement dispute with a health-care plan purchased in Alaska? There is nothing in place to handle this, and yet McCain insists on reducing regulatory oversight of the health-insurance industry. And this does not begin to discuss the proposals from McCain's campaign to cut Medicare and Medicaid funding.

Sen. Barack Obama, on the other hand, favors an insurance plan similar to that already adopted by some states. In this, residents may choose between private health plans or a public plan. Health insurers would be required to accept all applicants, and the public-insurance plan would compete with private plans. While not government-run, it should increase the number of insured and reduce the risk of individuals being overwhelmed with medical bills.

David Riley MD