With the general election about to begin, one issue certain to divide the Democrat nominee and Republican John McCain is "universal" healthcare. The Democrat will support it. McCain will not. The divisive matters: Cost, complexity and the role of private and public entities.

All of which are addressed in a new report on universal healthcare from the Commonwealth Fund.

The report, "Building Blocks for Reform: Achieving Universal Coverage with Private and Public Group Health Insurance," outlines a plan that, according to the authors, "provides a pathway to universal coverage with a minimal increase in total national spending and relatively modest net federal budget costs."

The basic plan: Retaining private insurance provided by companies and expanding Medicare coverage so it's available to all. It's very similar to the plans proposed by Hillary Clinton and Barack Obama, with a few key exceptions and specific figures.

• Those insured by employers would stay with their plans. The uninsured, self-employed and small businesses could buy "Medicare Extra" plans with estimated premiums of $259/month for individuals, $702/month for families. 
• Companies would have to offer insurance reaching a mimimum standard or pay into a system that will fund the Medicare Extra plan.
  
• People would have to demonstrate that they have insurance at tax time.

The authors estimate the plan would insure 44 million of the estimated 48 million Americans currently lacking health coverage, resulting in 99 percent of the population insured.

It would require $81 billion in federal spending in the first year.

Recall that when Hillary Clinton led a plan to achieve universal healthcare when her husband was in the White House, it was seen as far too complex. It collapsed due to lack of Congressional support.

Authors of the Commonwealth plan, perhaps understanding the need to make the plan understandable with simpler graphics, offer the following diagram. Time will tell whether it's sufficiently simple or clear.

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