By James Donahue

While both presidential candidates agree that the American health care system is in critical need of repair, they offer radically different plans for getting the job done.

Senator John McCain, the Republican nominee, appears to be sticking to GOP principles with a plan that leans heavily on competition in the open market. He wants states to take a greater role in creating such competition and forming “risk pools” that insure coverage for the sickest.

McCain is proposing a $2,500 annual tax credit to individuals and $5,000 to families to purchase their own insurance, and doing away with the tax exemption on employer-provided insurance. Thus he would encourage people to buy their own insurance the free employers from the heavy cost of providing for workers. He believes insurance companies would have to be more competitive in this kind of open market.

For sick folks who can’t guy affordable insurance in an open market, McCain’s plan calls on states to form risk pools, or “Guaranteed Access Plans” to provide coverage. He said there could be federal assistance for people who fall below a certain income level. The plan is estimated to cost about $10 billion a year in reduced tax revenues and subsidized coverage for the poor. This money would be offset by reduced government payments through Medicare and Medicaid.

The Obama plan would be designed to provide affordable, accessible health care for everybody, build on existing health care systems, and use existing providers, doctors and plans. He wants patients to be able to make health care decisions with their doctors rather than being blocked by insurance company rules.

Under Obama’s plan, if you like your current health insurance, you keep what you have with costs going down by as much as $2,500 a year. If you don’t like your present insurance plan, or if you don’t have health insurance, you will have a choice of new and affordable insurance options.

The Obama plan would require health insurance providers to cover pre-existing conditions, lower costs for businesses providing coverage for workers, deal with the high cost of malpractice insurance for doctors and establish a National Health Insurance Exchange with a range of private insurance options plus a new public plan based on the benefits available to members of Congress.

The plan also would lower drug costs by allowing increased use of generic drugs in public programs and allowing for the importation of safe medicines from other countries. Obama calls for hospitals to collect and report health care cost and quality data and a reform of the insurance market to increase competition.

Obama’s plan also would require coverage of preventive services like cancer screenings to promote improved public health.

He says he will pay the $50 to $65 billion cost of his health care reform by rolling back the Bush tax cuts for Americans earning more than $250,000 a year and retaining the estate tax at its 2009 level.