Wednesday, April 30, 2008

A point about McCain's plan

I sort of alluded to this issue in my previous post but reading a post at Time Magazine's blog "Swampland" right now it occurred to me that I should have been more clear and more precise.

John McCain's health care plan is based on the idea of undermining employer provided health insurance and forcing individuals into the insurance market on their own. If you like the health care plan your employer currently provides tough luck, John McCain is going to remove the tax incentives for your employer and send you out to purchase your own coverage. Oh, and he'll give you a tax credit to cover 40% of the costs.

In contrast both Hillary Clinton and Barack Obama's health care plans build upon the system that is already in place. As Senator Clinton says on the stump, if you like the plan you have now you can keep it.

John McCain will take your health insurance away, whether you want to give it up or not. Hillary Clinton and Barack Obama will let you decide what's best for you and your family.

As Karen Tumulty at Swampland rightly notes this is a risky political gambit for McCain,

In many ways, McCain is moving into far more treacherous political territory as well. As Hillary Clinton learned the hard way in 1994, it is dangerous to propose pushing people who are reasonably satisfied with their current coverage into a different system. (That's why every time she discusses her current plan, she starts by telling people that if they like what they have, they can keep it.) "Do people who have insurance in the workplace really want ot take the risk of moving out?" Blendon asks. "The history of the health care debate is that middle-income people in this country are risk averse."

I hope Democrats make this contrast clear as the election cycle moves forward.

If you're really interested in this Ezra Klein has more over at The American Prospect which touches on some of the issues I have raised already. A teaser,

Give McCain this: His philosophy is clear. McCain believes that Americans use too much health care, and he has created a plan that will make care less affordable so millions of Americans will use less. He even has a euphemistic description for this approach: "The key to real reform," he says, "is to restore control over our health-care system to the patients themselves … These accounts put the family in charge of what they pay for."

That's undoubtedly true. Parents weighing an emergency room visit they can't afford no doubt realize that they are in charge of what they are paying for. They are certainly more "price sensitive." They are certainly not acting with the wanton disregard of an insured family who seeks care for their feverish child without a second thought. The question, of course, is whether this sort of cost sensitivity is desirable.

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