Oct. 16, 2008 -- The health care discussion during Wednesday night's third and final presidential debate was dominated by a central theme: Would "Joe the Plumber" and the rest of us be better off under John McCain's health care plan or Barack Obama's?
One of the most heated exchanges of the night centered on the Toledo, Ohio, man whose encounter with Obama earlier in the week became an instant YouTube and media sensation.
Joe Wurzelbacher, who according to the Associated Press works for a plumbing business but is not a licensed plumber, told Obama that he expected to pay more taxes under the Democrat's plan because the business he planned to buy made slightly more than $250,000 a year.
Joe the Plumber was mentioned 23 times by the candidates during the debate, with no fewer than a dozen references dealing with the financial impact of the candidates' health care plans on people like him.
McCain claimed that if Joe became a business owner, he and other small-business owners would pay a fine under Obama's plan if they didn't offer a health care plan to their employees: "Now, Joe, you're rich, congratulations, and you will then fall into the category where you'll have to pay a fine if you don't provide health insurance that Sen. Obama mandates, not the kind that you think is best for your family, your children, your employees, but the kind that [Obama] mandates for you."
In an earlier exchange, Obama denied that small-business owners would be fined under his plan:
Obama: "I'm happy to talk to you, Joe, if you're out there. Here's your fine -- zero. You won't pay a fine, because ..."
Obama: "Zero, because, as I said in our last debate and I'll repeat, John, I exempt small businesses from the requirements for large businesses that can afford to provide health care to their employees but are not doing it."
Who Should Joe Believe?
So who was telling the truth?
Stephen Zuckerman, PhD, of the economic and social policy research group Urban Institute, tells WebMD that Obama has never specified how many employees a small business could have.
Robert Moffit, PhD, who directs the Center for Health Care Studies for the conservative think tank Heritage Foundation, agrees.
"Obama has never said how he will define small business, so we can't really know if Joe will pay the fine or not."
Karen Davis, who is president of the health care research group Commonwealth Fund, agrees that Obama has never specified who would qualify as a small-business owner under his plan or what the fine would be for businesses that don't qualify.
She says the fine under other proposed plans has been in the neighborhood of 4% to 6% of revenues.
Candidates Talk About Health Costs
McCain's plan would provide health care tax credits of $2,500 for individuals and $5,000 for families and eliminate tax breaks on employer-sponsored health care policies. He would also do away with restrictions on purchasing health insurance across state lines in an effort to increase competition.
In Wednesday night's debate, McCain said health care costs could be lowered by:
- Putting health care records online to reduce costs.
- Increasing the number of community health centers and walk-in clinics.
- Emphasizing physical fitness programs and nutrition programs in school.
- Encouraging employers to reward employees "who join health clubs and practice wellness and fitness."
Obama wants to mandate health care coverage for children and require health insurance companies to cover everyone, regardless of medical history. He would create a national health-insurance exchange with the goal of providing private or public health insurance for everyone.
Obama's specific suggestions for reducing health care costs included:
- Investing in information technology "to make the system more efficient."
- Making preventive care and the management of chronic illnesses like diabetes and heart disease a priority.
- Ensuring that insurance companies can't discriminate on the basis of pre-existing conditions, and negotiating with drug companies to lower medication costs.
Who Would Save Money?
Both candidates said their plans would save families money.
- Obama said his plan would cut the average family's premium by about $2,500 per year.
- McCain said 95% of Americans "will receive more money under my plan."
Davis called Obama's contention that his plan would save the average family $2,500 "defensible," based on estimates of individual savings under her own group's similar plan.
Moffit said the $2,500 figure came from an analysis by Obama's own health care policy advisors, based on projections of savings that would be derived if the plan were fully implemented.
He points out that several independent health policy experts have "dismissed the idea that savings of that magnitude are possible."
Zuckerman says even if the figure is accurate, "the notion that average family premiums would fall by $2,500 may not be the best way to think about this number."
That is because it is not clear where these savings will be realized, so individual employers or even the government are as likely to benefit as individuals.
Moffit defends McCain's claim that 95% of people will save money under his health care plan, pointing to a report published earlier this month by the policy analysts the Lewin Group.
The report estimated that in 2010 a typical family would save $1,411 under McCain's plan compared to $426 under Obama's.
The report also projected that 49 million Americans will have no health insurance in 2010 if neither plan is adopted, and that the McCain plan would reduce the number of uninsured by 21.1 million by 2010, compared to 26.6 million for Obama's plan.