Tom Miller, an economic adviser to presumptive Republican nominee Sen. John McCain (Ariz.), called the plans offered by Democratic candidate Sens. Hillary Rodham Clinton (N.Y.) and Barack Obama (Ill.) "presumptive" and "counter-productive," adding that both push for universal coverage before addressing costs. Miller questioned Democrats' emphasis on increasing public funding and government regulation of the insurance industry, according to CQ HealthBeat. Miller said that any significant change to the U.S. health care system "has to resonate with our political culture, our history," adding, "Our economy is a market-based economy."

Katherine Hayes, a health policy adviser Clinton, "highlighted the human aspect of the toll of high health care costs," saying that the government has a responsibility to provide coverage to all U.S. residents, CQ HealthBeat reports. She said, "I look at some of these Republicans and wonder if they've ever had to go in and buy health insurance coverage," adding, "Certainly we need competition in our health care system, but if you're going to receive federal dollars, you have to play by certain federal rules." In addition, Hayes noted that the uninsured add to the cost of health care, citing a study that found covering the health care costs of U.S. residents without insurance adds $922 to each family's premium.

Miller said Hayes' statistics were misleading. He said, "Covering (the uninsured) isn't going to make a difference in terms of your premiums." Miller also questioned Democratic proposals to increase regulations on insurers, specifically those that would prohibit companies from raising premiums on policyholders with pre-existing health conditions. According to Miller, McCain's proposal focuses on two kinds of personal responsibility -- wellness and finding the best coverage for each individual family. He said, "We weren't misinformed when we pulled up to the McDonald's two times a day."

Hayes and Dora Hughes, Obama's health adviser, both countered Miller by noting that low-cost foods are often the only option for families who cannot afford healthier choices. Hayes said, "What does personal responsibility mean? Does it mean that someone who is obese and has diabetes should be punished?" Hayes added that the Democratic plans avoid putting U.S. residents at "the mercy of the market."

According to CQ HealthBeat, the one issue on which the three advisers agreed was that "the health care system and the economy are inextricably linked" (Cooley, CQ HealthBeat, 5/19).

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