Where does much of our news content come from these days anyway?  I’ve seen a dozen op-eds this month reporting authoritatively that Hillary and Barack have nearly identical health reform concepts. Where do these lame analyses come from? The two candidates have very different approaches, with different strengths, weaknesses and implications for medicine.

Hillary proposes that all Americans must have coverage in five years through a pluralistic private sector approach. Her plan involves an individual mandate for uninsured persons, means to strengthen existing employer coverage and a commitment to take on the fight for major insurance reforms. She also supports somewhat unspecified quality of care improvements. While she proposes subsidies for lower income families, she would basically require everybody to pay their fair share of coverage costs, with nobody freeloading anymore.

Obama meanwhile proposes covering only kids 0 – 18 through expanded public coverage and then proposes to get costs down for everybody else by voluntary negotiations with insurers. (Whoever advised him negotiations will produce friendlier, more socially responsible for-profit insurers needs their meds adjusted.) Mr. Obama expects more people to voluntarily buy insurance. If this doesn’t work — and it certainly won’t without insurance reform with teeth — he favors a single payer system in the future, while Ms. Clinton has specified she does not favor that goal.

The only real commonality I see in the two approaches is that both propose to pay for the public costs of their ideas by reducing the Bush tax breaks to wealthy individuals. (Meanwhile, on the R side, Mr. McCain has no major access expansion or reform plan other than his desire to increase tax credits for individual coverage to incentivize greater coverage. He has not yet mentioned insurance reforms.)

Regardless, Mr. Obama is now the likely Democratic nominee, with good old Ted Kennedy advising. One take-home: We’d better focus carefully on what Medicare reform looks like, because it could be a much bigger program in five years. Another take-home: There really is no politically viable plan for reform on the table yet, giving us more time to help suggest one.