The bizzaro world of McCain's health care politics

By Matthew Holt

I sometimes write two different versions of pieces, one for you wonks at THCB and one for the more general crowd at Spot-on. Well to be more accurate I write one version which gets edited heavily over at Spot-on, so today here I'm putting up the THCB version of the one that went up on Spot-on yesterday.

My 6 weeks of traveling the world on an extended honeymoon is over. Thanks very much to Brian Klepper and the cast of thousands who’ve been keeping THCB rolling excellently while with my lovely wife Amanda I’ve been diving on coral reefs, sleeping under the stars with the Bedouin, exploring 3,500 year-old tombs, watching Lions tear apart a buffalo, and tracking chimps hanging out in the rain forest. (Pictures of all this and more to come, I promise)

So what better way to return than to enter the jungle of US Presidential politics? Yesterday I sat in on 2 conference calls. One from the McCain camp on their man’s health care proposal, the other from the Campaign for America’s Future, which is promoting Jacob Hacker’s plan as the theory behind both Clinton and Obama’s policy intentions. It wasn’t pretty.

McCain’s proxies were Douglas Holtz-Eakin, sensible former CBO director, and Carly Fiorina, the fired HP ex-CEO who has been rehabilitating herself by taking credit for her successor’s success, and been hanging out on the McCain campaign as adviser for tech. Apparently she’s on the VP shortlist, and if so, we got a lot of taste of what we can expect. The choice is between free market choice, and the government telling your family which doctor it can go and see. Yes, you’re going to hear “government run heath care care” alot as if we’re all moving to the Gulag.

(Carly also made an amusing slip when she said that McCain favored importing of generic prescription drugs. Generic drugs are of course usually cheaper here—it’s re-importation of branded drugs that McCain supports, which will lose him the odd contribution from PhRMA).

But no matter competition and choice is always cheaper—trust her.  But then again Carly knows all about succeeding in the free market, right?

 

After a lot of platitudes about medical homes and transparency and EMRs—all of which will magically appear under the McCain plan, Holtz-Eakin finally got down to the meat. The idea is that we’re more or less ending the employer-based system by taking away the tax deductibility of benefits. Every family will get a $5,000 tax credit, and use that to go buy insurance in the individual market, in which they will no longer be restricted to buying insurance their own state. At least Holtz-Eakin is sensible enough to get McCain to identify the problem associated with the main thrust of his plan—what happens when people are forced into the individual market.

The answer of course is that under such a system most healthy people will find a high deductible policy that costs less than $5,000, and those with pre-existing conditions, such as John McCain (were he not a Federal employee and eligible for Medicare) would find insurance unobtainable.

There is a rational way out of this for those (including me) who want to hasten the end of employer-based health insurance. You set up a regulated national insurance market which forces insurers to take all comers much as the Dutch have done, Massachusetts has made vague efforts towards, and (of course) Ron Wyden proposes. But to do that without killing the insurance market requires forcing everyone to buy in (as Arnold Schwarzenegger understood), and also means that benefits and options have to be made similar by regulatory fiat, and that a system of risk adjustment needs to be in place. Failing that the whole thing collapses, as the absence of an individual market in any of the semi-regulated states like New Jersey, or Washington demonstrates.

There’s no reason that McCain couldn’t have gone some way down that path. After all Wyden’s got a bunch of Republicans on board, and even Reggie Herzlinger (yes I know I spell her name wrong but so does she!) proposes some form of that.

But instead McCain’s answer to that problem is literally, “we’ll study it more”. Holtz-Eakin suggests that there are some states which have a solution to the high-risk uninsurables via their high-risk pools, and that this can be adopted nationwide. This is probably news to anyone in one of those pools. For example, just yesterday at the Texas state house a mother called Kyla was making this speech about how to get her sick child into the state high-risk pool, her husband is going to have to take a pay-cut! Go read her story. And then of course think about access to those pools when multiplied by thousands of new applicants under the McCain plan.

This of course should be hay for the Democrats and the AFL-CIO and Campaign for America’s Future were very persistent in letting you know that 1) McCain wants to take away employer-based health insurance and 2) you’re on your own in the individual market. Funnily enough in the call yesterday they focused on point one, rather than explaining the obvious about point two—the individual market is run by insurance companies in California that retroactively cancel all sick people’s policies, and that under the McCain plan that’s the only place you’d be able to buy insurance! But I’m sure we’ll hear loads more about that come the Fall.

And who’s the politician in California who’s been most aggressive about pointing out the flaws of said insurers? Yup, it’s Insurance Commish Steve Poizner who is (you’ve guessed it) a Republican.

So why is straight talking maverick John McCain (who believes in communist conspiracies like global warming and re-importing drugs) spouting the NFIB/Cato line on health care reform? After all, isn't this a great area to be a maverick and deviate from the Bush line?

I assume that the answer is McCain feels health care is important enough that he has to say something, but he’s more concerned about not upsetting the health care industry. After all, even if he does (by some miracle/Democratic ineptitude) win the election, he’s not actually going to do anything about health reform. But then again, my guess is neither are the Democrats.