CHICAGO (Reuters) - An analysis of the two starkly different approaches to reforming the U.S. health care system offered by John McCain and Barack Obama suggests Obama’s plan has the best chance of making health care more affordable, accessible, efficient and higher in quality.

Democratic presidential nominee Senator Barack Obama waves to supporters at the end of a campaign rally in La Crosse, Wisconsin, October 1, 2008. REUTERS/Jason Reed

The report, released on Thursday by the Commonwealth Fund, sized up the presidential candidates’ plans for dealing with a health care system which has left nearly 46 million people uninsured and many more underinsured.

According to the report, Democrat Obama’s plan would cover 34 million of the nation’s projected 67 million uninsured people in 10 years, compared with just 2 million covered under Republican John McCain’s plan.

“It’s a plan that tries to deal in a serious way with the uninsured,” Karen Davis, president of the Commonwealth Fund, said of Obama’s plan in a telephone interview.

“That is clearly a top priority. He doesn’t eliminate it, but in my view he cuts it in half over a 10-year period.”

Obama’s plan seeks to build on the current employer-based insurance system, which now provides coverage to 160 million people, or more than 60 percent of the population under 65.

His plan would require all employers except small businesses to either offer health insurance or contribute to the cost of coverage. It would replace the current individual insurance market with an insurance exchange in which small businesses and those without access to coverage could buy a private or public health plan with tax credits.

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The plan also eases qualifications for low-income families to be covered under Medicaid, the state-federal insurance program for the poor, and the State Children’s Health Insurance Program.

Obama’s plan is most like a plan put forth earlier this year by the Commonwealth Fund, which would also build on the current employer-based health system.

MARKET SOLUTION

McCain’s plan seeks to put health insurance into the hands of individuals by removing tax breaks for employer-paid health benefits and offering tax credits of $2,500 for individuals and $5,000 for families instead.

“I think Senator McCain’s plan is more concerned with health care costs and doing something about that through a market solution. It’s basically saying let’s have people buy their own insurance,’ Davis said.

McCain would also ease state insurance restrictions and allow people to buy policies across state lines, and he would expand existing state high-risk pools for people who cannot get individual insurance because of health problems.

Researchers at the Urban Institute-Brookings Institution Tax Policy Center project McCain’s plan would reduce the number of uninsured by 1.3 million in the first year at a cost $185 million. About 20 million people would lose their employer-sponsored coverage under McCain’s plan, but 21 million would gain coverage on the individual market.

Obama’s plan in its first year would reduce the number of uninsured by 18.4 million at a cost of $86 billion.

Over 10 years, McCain’s plan would cost $1.3 trillion and Obama’s would cost $1.6 trillion, according to the report.

Neither plan would offer universal health coverage, but Obama’s plan would mandate health insurance coverage for children.