How the Next President Tackles Health Care

ABC News Medical Editor<br>Oct. 28, 2008&#151; -- Forty seven million Americans -- most from working families -- have no health insurance, and 25 million more are considered "underinsured," meaning they have health insurance but not enough to protect them from high medical bills.

Now, with the fear of an economic recession, tens of millions of additional workers are worried about losing their health benefits if they lose or change jobs. The plans proposed by Sens. John McCain and Barack Obama to address the situation reflect two very different ideas about health care reform.

The candidates have classic Republican and Democratic views about what roles the federal government and the private sector should take to solve the nation's health care crisis. Fundamentally, the Obama plan wants to increase employer-based insurance with government help, while the McCain plan wants to enter people into the private insurance market.

Drew Altman, president and CEO of the nonpartisan Kaiser Family Foundation, notes that the McCain plan is, in fact, the more radical solution.

"The Democrats want to spend more to cover more people, but the Republicans are actually proposing the bigger change -- moving away from, moving people out of, the existing employment-based system," Altman said.

Currently, 160 million Americans get their health insurance from an employer, and according to surveys from the Commonwealth Fund, a private foundation specializing in health policy research, most people want to keep it that way, for a variety of reasons.

"There are better premiums, there are better benefits … you've got a human resources manager to help you out if you've got a claim denied," said Commonwealth Fund President Karen Davis.

But with U.S. health care costs spiraling out of control -- estimates say we'll top $3 trillion in three years, and reach $4 trillion by 2016 -- health economist Gail Wilensky, former Medicare head and now a McCain campaign adviser, believes workers should be encouraged to purchase their own private health insurance.

She says Americans will become cost-conscious if they have to pay their own way. And she cautions that the cost of the Obama plan to the federal government could be very high -- "between $60 to $120 billion more than the very expensive health care we already have," she said.