DaytonDailyNews.com

Even if Sen. Hillary Clinton were the Democratic nominee for president, today you would be hearing much less about her plans for getting health insurance for everybody.

Though that's her passion, even she would have difficulty focusing on the issue, what with Wall Street's meltdown and the expensive bailouts that are pending. That there's a more universal problem — in such a rich country — than the need for universal health care is a statement about how dire the times have become.

Still, best to know where the two presidential candidates stand on how to insure some or all of the 45 million uninsured and to keep costs down.

The changes that both Sen. Barack Obama and Sen. John McCain are talking about are so big and fundamental that estimates about costs are just wild guesses. If you really overturn the current system, people's behavior will change in ways that computer models haven't even begun to anticipate.

Sen. Obama would require all but small employers to provide health insurance to their workers or pay a tax. That tax — Sen. Obama doesn't say how much it would be — would go toward creating an allegedly affordable (and government subsidized) health plan that workers could buy into with their own money.

Some people worry that having a subsidized government plan would encourage employers to stop providing coverage, thus essentially ending the current setup where businesses do a lot of the comparison shopping and buy insurance for large groups of people, which helps spread the risk around.

Another concern is that employees might prefer a government-sponsored program, assuming it's more generous than the plans offered at work.

Sen. McCain is critical of Sen. Obama's mandate and the unspecified tax.

The Republican candidate would give families a $5,000 tax credit ($2,500 for individuals) to purchase health insurance in the open market, which would make premiums more affordable for some people.

If, however, your employer provides coverage, the value of that benefit would be taxed as income. This change would address the unfairness in the fact that people who buy health insurance on their own don't get a deduction for the expense.

To break even financially under the McCain plan, some people would have to settle for inferior coverage as compared to what they currently have. But there's also an argument that if consumers don't have Cadillac policies, they'll be more careful about not running up health-care costs.

Experts say that Sen. Obama's plan would be much more costly than Sen. McCain's, but that Sen. Obama's would bring more uninsured people into the system.

Where the money would come from to pay for either plan isn't totally spelled out, if you assume — and you should — that both men are overestimating how much they can save through computerizing medical records and such reforms. Most likely, both will have to go back to the drawing board on costs.

In their town hall debate, Sen. McCain said access to health care was a responsibility. Sen. Obama said it was a right. Ideally, it should be considered a right. But getting there is tough and becoming tougher.