WEDNESDAY, Aug. 20 (HealthDay News) -- The health care plans proposed by John McCain and Barack Obama would have uncertain effects on health care coverage in America, but potential problems with each plan are evident, according to a perspective piece in the Aug. 21 issue of the New England Journal of Medicine.

Jonathan Oberlander, Ph.D., of the University of North Carolina in Chapel Hill, writes that the McCain plan focuses on eliminating the tax exclusion for employer-paid health insurance premiums, and using the resulting revenue to pay for refundable tax credits for people buying private insurance. However, most who are currently uninsured would likely remain that way under the new plan, the author writes, since even with the credit, insurance would still be unaffordable for many.

Obama's plan would require most employers to offer insurance to their workers or pay a tax that would help pay for coverage for the uninsured. It would also establish a new government health plan and a national health insurance exchange offering private insurance. However, this plan could result in a large enrollment in a new national health plan, and it doesn't have a viable source of financing or reliable cost-control mechanisms, the author writes.

"The candidates' opposing visions of health care reform reflect fundamentally different assumptions about the virtues and vices of markets and government. With the debate over how to reform U.S. health care far from settled, whoever wins the presidency can expect fierce opposition to any attempt at comprehensive reform," the author concludes.

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