Health care is a pressing and constant concern in America, 45 million Americans don't have health insurance and people keep asking the candidates what they are going to do about it. Both Bush and Kerry have detailed plans, but experts at the Wharton School don't think either plan will be implemented, nor would they achieve the desired goals even if they were:

Would either proposal solve the three broad issues facing American health care: mushrooming cost, inadequate availability and uneven quality? Is there any way to stimulate market efficiencies to contain costs and get care to the 45 million Americans who don't have insurance?

Three Wharton health care experts doubt either candidate's plan could be enacted as proposed - or would lick all those problems if it were. The problems are so complex, and Americans' expectations of top quality affordable care are so deeply rooted, that it's far from clear there is any satisfactory solution for the near term. "I don't think either of them has a clue how to do it," says Mark V. Pauly, professor of health care systems at Wharton.

....President Bush wants to encourage people to find insurance on their own. He has proposed tax credits to make insurance more affordable to low-income people, and he wants to extend the reach of Health Savings Accounts, created early in 2004. These allow participants to put pre-tax money into accounts similar to 401(k) retirement accounts. Participants buy health insurance with high deductibles - at least $1,000 a year for an individual, $2,000 for a family. High deductibles are meant to keep premiums as low as possible. Money from the tax-free savings account would be used to pay deductibles, and it could build up over the years. Bush wants to make premiums tax deductible as well. And he'd tackle the soaring cost of malpractice insurance with tort reforms such as capping awards for pain and suffering.

The total cost for Bush's plan is estimated at about $90 billion over 10 years.

Kerry's plan is estimated to cost seven to 10 times as much, perhaps more, but it would bring coverage to some 27 million people who don't have it now. That's about 10 times the reach of Bush's proposals. Kerry wants to pay for his plan by rolling back the Bush tax cuts for taxpayers making more than $200,000 a year.

Kerry calls for a government insurance pool that would cover 75% of the cost of any individual claim exceeding $50,000. That is intended to reduce employer premiums, encouraging more companies to offer coverage. He also would allow ordinary citizens to participate in the health coverage provided federal workers such as members of Congress. And he would loosen eligibility requirements for participation in Medicaid and the State Children's Health Insurance Program.

....But neither approach would do enough to change the market forces that keep driving health costs higher, says Lawton R. Burns, professor of health care systems at Wharton. "There are other approaches that would have a bigger impact on markets."

Many factors drive health care costs up. The public sees the problem as one of rising prices, ignoring the fact that quality improves at a dramatic rate. Today, people get joints replaced and have laproscopic surgery to repair damage that past generations just lived with. "It's increasing because there are now more expensive products and ways of using old products," says Pauly. "Now everyone gets their cholesterol lowered."

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