Aside from the specifics of the various plans/proposals, there is the factor of the track record of the three individuals. Reforming the way health care is delivered is not going to happen without consensus across the political spectrum. Only one candidate, McCain, has a proven record of reaching across the aisle to get things done (it's why many Republicans hate him). Hillary took a swing at this very problem--it's the only significant policy initiative she was ever entrusted with, and she failed miserably (due primarily to her poor ability to gain consensus and build trust--personal skills that she does not appear to have enhanced).
I understand why some people like the VA health care system, and especially what it represents. It is perfectly egalitarian, and it is cheap. If this system is the example that universal health care proponents are going to hold out to the public as a success, they can save themselves a lot of time by just folding up their tent right now.
We can fix what is wrong without making everyone buy a Mao jacket.
- De-link health insurance from employment. If we just eliminated the tax break employers get in this area, we'd be 90% of the way there (since employers would stop offering coverage and would instead compete for workers by offering enhanced pay-which employes could use to buy their own insurance).
- Standardize coverage types (ala Medicare supplemental policies). This creates a more efficient market by standardizing the coverage packages. it has been successful in significantly reducing costs. Providers compete on price and service. You buy the policy you want.
- Underwriting/physical exams: Nope. If a company offers a particular coverage package (see above) to one person, it must offer it to everyone. This eliminates the problem of adverse selection.
- Cross-state portability: I confess that I'm torn here. I'm a "local control" fan, but if every state can make their own rules then the market won't be as efficient and people might end up shackled to their state of residence just as they are now shackled to an employer.
- The poor: We could go two ways:
-- The government gives them a voucher for the "basic" standardized coverage type (see above). Expect to have basic medical care, to share a room with a few other people in the hospital, and to have to wait for diagnostic tests. You might need to take a bus to a nearby city for that MRI rather than go to the nearer posh "designer" hospital.
-- Expanded VA-type care. Government (or government-contracted) doctors, no right to sue in cases of adverse outcomes, and a lot more PAs than MDs.
Either of these options would provide the same standard of care offered by the Western nations which have socialized medicine. In the US, this care would be paid for with taxes--money forcibly taken from other Americans. In fairness, it should not be better coverage than these Americans (who earned that money) can afford to provide for themselves.
Yes, people should still be free to buy their own health care out of pocket--this is still America. Look at the Canadian experience for examples of what happens when this option is closed.
