May 5, 2008

Sen. McCain's Health Care Plan

Sen. McCain has taken the necessary, but nevertheless bold, step of proposing a health care plan and platform for his campaign. It's available from his campaign's web site. Here my reactions to it thus far.

The overall vision of the health care plan seems generally sound and in accord with my positions elsewhere on this page: that people, not the government, should have more control over their health care. This will encourage them to make responsible decisions and control prices better.

As I see it, the overall problem with the plan (as well as its most clever aspect) is its reliance on health insurance as it is used today. That is, the plan continues to promote our current system of using health insurance, not like other insurance to cover disasters that would otherwise bankrupt people, but instead on everyday health matters. I think that using health insurance for health maintenance is a mistake, but I must acknowledge the vast disruption that would occur were we to try to move to an ideal system. Sen. McCain's plan is clever because it continues to use health care for routine personal care and doesn't overturn the vast systems we've created, or force us to relearn how to visit the doctor.

I am in favor of the portion of Sen. McCain's plan to further Health Savings Accounts, but I am leery of his proposal to use a tax refund for insurance premiums. I think we should all dread the prospect of more forms, another calculation to evaluate, and money flying around various bureaucracies. Frankly, I'd prefer it if instead of a refund, taxes were lowered outright. Once again, however, Sen. McCain's plan is likely to be more politically feasible. It's easy to grandstand against a tax cut, but less easy to oppose a tax refund for health care.

The proposal in the plan to create coverage for people who have difficulty obtaining insurance appears to be a Herculean task. It'd be nice to think that a consortium of state governments could manage to pool their resources and help these people acquire coverage, but I have two reasons to doubt its entire success. One is the experience of Florida's continual battles against hurricanes and fleeing insurers. Despite decades of experience with both, and multitudes of laws and a similar plan to cover the uninsurable, insurance for homes is available from few providers and is still at extremely high prices, if it is available at all. The second reason I doubt a coalition of state governments will function as intended is my memory of the last time there was a massive coalition of state governments. That time was the great tobacco lawsuit of the 90s. Despite many assurances from state governments that the money from the settlements would only be used to fund anti-smoking ads, the money nevertheless found its way into the hands of politicians who used it for other purposes in state budgets. I fear there could be similar results from this part of Sen. McCain's proposal.

Speaking of smoking, I'm troubled by Sen. McCain's plan to combat chronic diseases, specifically the early prevention parts. The idea of heading off a problem is deeply American. Benjamin Franklin wrote that "a pound of prevention is worth an ounce of cure." Nevertheless, I worry that recent shifts in the definition of diseases could create an opportunity for expanded government meddling in the lives of citizens. Smoking and obesity are now commonly called diseases. Would disease prevention eventually mean even more prohibitions against smoking and rationing of candy for adults? It seems silly now, but the idea that a government would have the power to ban trans-fat, to tell a free people what we can and can not eat, would've seemed silly only a few years ago. I don't want to find out what government would do with the new power it could gain through this proposal.

Despite its flaws, there are many good ideas in the plan, such as greater reliance on individual initiative and promotion of health insurance portability. I think it, on the whole, a far more sensible plan than many others that have been offered for our nation.