How surprised was I just now, when skimming the titles of tomorrow’s issue of the New England Journal of Medicine, to see as authors of the lead perspectives two non-scientists and non-doctors: John McCain and Barack Obama! What’s going on?

It turns out that those smart editors over at the NEJM asked the two candidates “to describe their plans for reforming the U.S. health care system.” What perfect timing, considering last night’s much talked-about debate question of whether health care is a right, a privilege, or a responsibility (Obama said it was a right; McCain a responsibility).

The NEJM is, happily, a much less suitable forum for soundbites and platitudes. I was extremely surprised by the extent to which Obama did not argue for total socialized medicine and McCain did argue for an increase in certain government oversight/regulation—that is, the two plans don’t seem as different as I thought. Here’s the gist of their answers, with links after each to the full text.

Barack Obama:

Under my plan, if patients like the insurance they have, they keep it and nothing changes, except the costs are lowered. For those who are left out or have substandard insurance, my plan will offer a choice of affordable health insurance plans. Through a national health-insurance exchange, people without employment-based insurance or who work in small businesses will have a choice of private insurance policies at rates similar to those offered through large firms. To promote competition among insurers, we will also give patients a new public-plan option, providing the same coverage that is offered to members of Congress and their families.

…All insurance companies will have to take everyone, regardless of medical history. Like too many Americans, I watched my mother argue with insurance companies while she was in bed dying of cancer; that should not happen.

…I will invest in programs, including loan repayment, training grants, and improved provider reimbursement, to give young doctors incentives to enter primary care. I will also renew our commitment to investing in biomedical research, which suffered a major lapse under the Bush administration.

Finally, I will address medical malpractice with the central goal of preventing medical errors in the first place. Through substantial investment in information and decision-support technology and other patient-safety initiatives, we will reduce the types of medical errors and oversights that lead to lawsuits. And I am open to additional measures to curb malpractice suits and reduce the cost of malpractice insurance. We must make the practice of medicine rewarding again. (Read the full text.)

John McCain:

While we take steps to lower health care costs, we must also improve access to health insurance. An important part of my plan is to replace the current tax exclusion of the value of health insurance from employees’ taxable compensation with a new refundable tax credit of $2,500 for individuals and $5,000 for families. Families can use the tax credit to continue their employment-based insurance or to find a plan that better meets their needs.

Families who have job-based insurance today will see little to no change and will continue to keep their current coverage. In fact, millions of American families with employer-sponsored coverage will be better off under this fair and equitable system. However, for the first time the credit will provide help to people who are shut out of the job-based insurance system; they will be able to choose an insurer or other health care arrangement, and the credit will be sent straight to the plan they pick in order to help pay their premiums.

…No American should be denied access to affordable coverage simply because of a preexisting condition such as cancer. I will work with states to create guaranteed-access plans that will ensure high-quality coverage, with reasonable premium limits, for these Americans and additional help for low-income individuals.

…Our tort system is an invitation to endless, frivolous lawsuits by trial lawyers who exploit patients and physicians alike. I understand that the fear of lawsuits not only forces doctors to perform unnecessary tests but also often poisons the relationship between patients and doctors. That is why I have been a consistent advocate of medical-liability-reform legislation, and I believe it must be a central aspect of any health care reform effort. (Read the full text.)