Corinne Ramey

Where Do the Candidates Stand on Health Care? John McCain

John McCain's campaign is littered with rhetoric about "straight talk," and he travels around the country on the "Straight Talk Express." But when it comes down to it, how much "straight talk" in McCain giving voters in his " Straight Talk on Health System Reform" plan? Now that the New Hampshire primary has catapulted McCain into front-runner status, I'll give you some straight talk on what McCain's plan means for the current and aspiring middle class.

But the word "plan," perhaps, is an exaggeration. McCain doesn't so much have a plan as a list of bulleted talking points describing what a potential health care plan could look like. Unlike the detailed plans of his Democratic competitors -- I've written about Clinton's, Obama's, and Edward's plans in the past -- McCain's plan includes nothing of specific proposals or budgetary figures. However, his talking points and a speech that he gave at a Des Moines, Iowa rotary luncheon provide at least a general idea of what health care under McCain could look like.

First, let's start with the problem. Wisely, McCain acknowledges that the current state of American health care leaves something to be desired. He calls it the issue that comes up most frequently in discussions and polls, "outside of the pre-eminent challenge of our time - the threat of Islamic extremists." However, the way McCain defines the problem doesn't align with that of most middle class Americans. McCain said, in his Iowa rotary luncheon speech:

"The problem, my friends, is not that Americans don't have fine doctors, medical technology and treatments. The state of our medical science is the envy of the world. The problem is not that most Americans lack adequate health insurance. The vast majority of Americans have private insurance and our government spends billions each year to provide even more...The biggest problem with the American health care system is that it costs too much, and the way inflationary pressures are actually built into it."

Costs, undeniably, are a huge problem. After all, the U.S. spends more on health care than any other industrialized nation, and costs are expected to reach $2.9 trillion by 2009. In 2006, employer health insurance premiums increased at twice the rate of inflation. But, contrary to what McCain says, there are plenty of Americans out there who lack health insurance. Forty-seven million of them, in fact. During 2006 and 2007, 89.6 million Americans under the age of 65 went without insurance. Four out of five Americans uninsured during that two year period were in working families. And that doesn't even include all the people who are underinsured, or who have insurance that doesn't allow them to engage in appropriate preventative care to cut future health care costs.

In order to control costs, McCain proposes a combination of tax credits and health savings accounts. According to McCain's plan, individuals would receive a $2,500 tax credit and families would receive a $5,000 tax credit if they bought health insurance. Through the tax credit, McCain hopes to encourage people to purchase health insurance individually instead of purchasing it through their workplace. "What more compelling evidence of the problem do we need than to note that General Motors now spends more for health care of its employees and retirees than for the material required to manufacture its products - steel. The price of every GM car includes over $1500 for health care costs," he said in Des Moines. If people buy their own health care, as opposed to receiving it through their employer, the economy will be better off as a whole.

And, on one level, he's right. Skyrocketing health care costs are making our economy less competitive, and, in some cases, even forcing employers to move to Canada. But just offering tax credits isn't enough to solve the problem. Because Americans can keep the rest of the tax credit that they don't use, they'll likely buy plans with higher deductibles and then buy less care, especially long-term cost saving measures like preventative care. As McCain says, "When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices." Sure, they're going to choose a less expensive option if they are paying for it, but does that do anything to improve quality of care? As Ezra Klein smartly wrote of the McCain plan, "It's like if I tried to make food cheaper by encouraging you to diet." And, as I've written in the past, a large tax credit doesn't do much for low-income Americans who aren't paying much in taxes in the first place.

McCain, as part of his "genuinely conservative" health care plan, does strive to offer more "personal freedom" when it comes to plan choice. He says that insurance should be portable across state lines, continue regardless of changing employers, and be allowed to be purchased from different sources such as "employers, individual purchases, churches, professional associations" and other groups.

McCain does have one interesting policy component that separates him from the other candidates. He wants to change fee-for-service medicine so that doctors and providers are paid based on results, not on procedures. According to McCain,

"We need to change the way providers are paid to focus their attention more on chronic disease and managing their treatment. This is the most important care and expense for an aging population. And in a system that rewards quality, Medicare should not pay for preventable medical errors."

As Slate's Timothy Noah writes, "Possible reform in this area would be far more radical than anything proposed by the Democratic presidential candidates, even if confined only to Medicare." However, McCain doesn't go into detail about how exactly the change would be carried out.

The rest of McCain's proposal, however, consists mostly of platitudes, or proposals that are nice -- like "Public health initiatives must be undertaken with all our citizens to stem the growing epidemic of obesity and diabetes, and to deter smoking" -- but give absolutely no details about how they would be carried out.

For now, it seems like there is an utter lack of straight talk on health care from the candidate traveling the country on the Straight Talk Express. Unless McCain comes out with concrete details for a plan that will actually ensure that ALL Americans have access to quality and affordable care, it's unlikely that a plan like his would make American health care any better for the American middle class.

Posted at 6:53 AM, Jan 14, 2008 in The Candidates on Health Care | Permalink | Comments (5)