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Michael L. Millenson Headshot

McCain's Health Care Plan Radically Irresponsible

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What a disappointment. Here Barack Obama accuses John McCain of pushing a "radical" health care plan, and instead of grabbing the chance to don a scarlet "R," the would-be change agents of the McCain campaign bristlingly respond with business-as-usual. It is Obama, they say, who harbors secret ties with dangerous bomb throwers.

In reality, you don't have to be a health-care expert to immediately understand just how fundamentally radical the McCain plan is. Whether or not you are a fan of free-market health care, what is it if not radical to propose dismantling the employer-based insurance structure that covers 150 million Americans and has been the foundation of our health care system since the end of World War II? Before the war, about 10 percent of Americans had health insurance. By the mid-1970s, 90 percent did.

By comparison, the Clinton administration's much-reviled plan of the early 1990s looks like mere tinkering, albeit tinkering that came with a 1,000+ page instruction booklet. The McCain folks have certainly learned the virtues of vagueness. Their plan does not trouble itself with much detail beyond "take apart group coverage, elevate individual coverage and trust that the whole thing puts itself together again even better than before." In other words, this is faith-based economics for a stunning one-seventh of the U.S. economy.

To put the $2.4 trillion spent annually on health care into perspective, it equals three-and-a-half Wall Street bailouts all strung together. It is an apt analogy, since McCain says that health care is plagued by an excess of regulation and a surfeit of free-market competition. Not surprisingly, fervent ideologues of the far right believe they have found a fellow traveler, and they don't shy away from the "r" word.

As an op-ed in the ultra-conservative Manchester (NH) Union-Leader noted back in July: "Sen. John McCain is proposing...[a] radical overhaul of American health-care policy." Author Michael Tanner, a senior fellow at the libertarian Cato Institute, concluded that it is "a radical change, and it is right."

Apparently being called a radical rightist is OK as long as only other radical rightists hear about it.

Yet radical change can sometimes be a good thing. Worse than being radical is being irresponsible, and the McCain health care plan is just plain sloppy.

Let me explain. There is a cogent argument to be made from the right for blowing up our current employer-based system, just as there is a similarly cogent argument to be made from the left for doing the same thing by adopting single payer. Republicans from Bush, Cheney and McCain on down have regularly and inaccurately tried to scare voters into thinking that any health care reform plan proposed by a Democrat is part of a (radical) single-payer plan, but that is a discussion for another time.

Genuine single-payer advocates that I know have a thoughtful and detailed plan for implementing their vision. Similarly, there are conservatives who have thought through the appropriate role that government regulation and subsidies must play in ensuring that people who have a pre-existing condition such as diabetes or cancer are not abandoned in the marketplace. The McCain plan, however, does not reflect those deliberations.

Unlike Obama, who made health care reform a cornerstone of his campaign - and who has been deeply involved in the issue since his Illinois Senate days - McCain has made health care an afterthought. While Democrats squabbled in their primary over the details of covering the uninsured, McCain laid out only the barest of health reform proposals, and nothing for the uninsured, until after he secured the nomination.

The current McCain plan makes no pretense of taking more than a preliminary step towards covering the uninsured, even though there are plenty of Republicans who could help him go much further. As a recently released report by the Commonwealth Fund put it, Obama's plan would cover 34 million of the nation's projected 67 million uninsured people in the coming 10 years, compared with just 2 million covered under McCain's plan. And that's over an entire decade!

McCain's math on the subsidies needed to help those with pre-existing conditions afford insurance ludicrous, and the heart of his proposal - that it effectively addresses the overriding problem of cost - is hollow, even when taken on its own terms.

What is most frightening about the McCain plan, then, is the way it reveals a reckless man who can't be bothered to learn the details about the havoc his ideological obsession will wreak on the innocent bystanders known as the American people. If that's not the definition of a bomb-throwing radical, I don't know what is.