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POSITION PAPERS FOR THE NEXT PRESIDENT

Health and education

This is the fifth editorial in a weeklong series on the issues and challenges facing the next president. The full series is available at latimes.com/positionpapers.

October 16, 2008

With crises as riveting as failing banks, rising layoffs and mordant mortgages, the electorate is paying less attention to how Americans will obtain health insurance and a good education. That's understandable in these days of urgency. But in the long term, there is no thriving economy without a healthy, educated population, and the United States is losing ground on both of these fronts. The worsening employment situation will reduce even further the number of Americans with health insurance; over the last 20 years, the percentage of the nation's workers covered by employer-based plans has fallen by more than 10 points.

The two presidential candidates have marked out distinct territories on healthcare coverage, and it's not surprising that Barack Obama tilts more toward guaranteeing some level of coverage for all, while John McCain would rely more on deregulation of the insurance industry and individual choice. Obama's plan fails to provide the vision that would break American workers out of a system that has them working for an insurance card almost as much as for a paycheck. And although there are certain elements of McCain's plan that hold promise, his full proposal threatens to dismantle healthcare coverage rather than spread a safety net under worried Americans.

Obama's plan at least represents an improvement over where things stand today. He would build on the existing base of employer-provided health insurance by requiring large businesses to offer coverage and establishing a national program, something like Medicare, for small businesses and uninsured individuals. He would alleviate costs to businesses through a "reinsurance" program that would, in essence, insure the insurance companies for the most drastic medical expenses, such as organ transplants. That reinsurance and the national program, though, are costly. Taxpayers would shell out $1.6 trillion over 10 years for Obama's plan, compared with $1.3 billion in that time under McCain's plan, according to the nonprofit Tax Policy Center.

The Times' editorial board has favored the concept of individual mandates, which would require everyone not otherwise covered by health insurance to purchase it. McCain calls for a sort of "mandate lite," providing a tax credit of up to $2,500 for individuals and up to $5,000 for families that purchase their own, private health insurance. It's how he melds this with other reforms that gives cause for alarm: He would tax employer-provided coverage as a form of income and deregulate the industry so that insurers could sell policies across state lines.

Taxing workplace-provided health insurance would knock the legs out from under group insurance, driving more people into the individual insurance market, a scary place that would be made even more frightening by deregulation. California is among the states that have been mandating insurance coverage for certain procedures -- such as mammograms -- and restricting insurers from unfairly dropping customers from their rolls. All that would be undone if insurance companies could sell nationwide from the state with the fewest regulations.

Ultimately, there might be value in separating health insurance from employment; many a worker clings to a bad job for the healthcare benefits. The problem is that McCain's plan doesn't replace this system with anything solid. The tax credit would work for healthy young people who can buy cheaper insurance, but would leave older people struggling to find insurance they could afford. The big attraction of individual mandates is the pooling of younger people, who cost insurance companies less, with those whose needs and expenses are greater.

McCain's preference for individual choice carries over into his education plan; its cornerstone is the expansion of private-school vouchers, a destructive direction for public education. To start with, the limited voucher programs that exist have not been shown to work. But vouchers also move the nation away from accountability. Private schools don't have to hire well-educated teachers; they don't have to test students; they can teach whatever they want, including creationism or Scientology. All of that is fine for parents who don't mind paying for it, but the public should not pick up the tab.

McCain has voted for abstinence-only sex education, which has proved ineffective in numerous studies, and for requiring schools to allow prayer. He has supported allowing the inclusion of creationism in science curricula. The country needs a president who will end this struggle, not perpetuate it; religious instruction should take place outside of public schools. Period. McCain is on firmer footing when he calls for strengthening the teaching corps by expanding nontraditional ways to get teacher certification.

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