Health policy proposals can reflect many different ideologies or political philosophies, but John McCain's plan isn't so much ideological as utilitarian. There has been a lot of excellent analysis of it in recent days, but one critical aspect has somehow been overlooked: The McCain plan, if enacted, would result in an enormous transfer of wealth from the general public to large American businesses.
In that sense, it reflects a lot of what passes for "conservative" ideology nowadays. There is no underlying belief system, just a mixed bag of policies - some "pro-big government" and some "anti big-government" - that share only the ability to enrich the large corporate donors that finance Republican campaigns.
So Republican political platforms are often little more than ideological smokescreens for policies that benefit these special interests. That's why large corporate donors support think tanks that do nothing but cook up these kinds of proposals. The "maverick" McCain is now a strict adherent of this pseudo-conservative line, and his health plan reflects that. It's pro-free-market where that benefits his party's backers, and anti-free-market where necessary to provide the bill with enough political cover to be palatable.
(I don't usually sound so populist when reviewing health policies. But it's good to look at what a plan would actually do if enacted, rather than what its backers say it would do, and this is what was most striking.)
How would this transfer of wealth take place under the McCain plan? First, its important to note that most under-65 Americans with health coverage receive that coverage through their employers. The employers who provide health benefits aren't small businesses - they're medium to large companies. While these companies receive a tax break for providing coverage, it isn't enough to cover their costs.
What would the McCain plan do for them? First, it would destroy the employer-based system by eliminating tax breaks for companies that offer health care. As a result, nobody would have employer coverage anymore. Since businesses are paying far more in premiums than they're been getting in tax breaks, they'll save an enormous amount of money. But unlike Sen. Ron Wyden's plan, for example, the McCain plan would not require these employers to give this sudden windfall back to their employees as salary increases. America's businesses would enjoy a huge reduction in expense without being asked to give anything back.
In return, individuals and families would be given tax breaks to go out and buy their own health coverage, but without the buying power of larger employers. So here's what's likely to happen in the real world under the McCain plan, based on what we've learned so far:
1. If a family gets a $5,000 tax break but the typical family premium is $12,000, they'll either pay $7,000 out of pocket or go without coverage.
2. People with pre-existing conditions won't be able to get private coverage.
3. McCain will encourage the states to take on people with pre-existing conditions by creating "high-risk pools."
4. But high-risk pools at the state level haven't worked very well. So people with pre-existing conditions will either go without insurance, remain uninsured, or state taxes will skyrocket to cover their costs. That means even more money out-of-pocket for individuals, in the form of higher state taxes.
5. Cost controls on premiums are sketchy. That means the $12,000 average premium will probably go up, too.
The end result? More out-of-pocket expenses for individuals, terrible difficulties obtaining coverage if you have a pre-existing condition, and an enormous financial break for larger American businesses.
This plan is more likely to pass than previous Republican proposals, since it includes high-minded suggestions like that state-based "Guaranteed Access Plan" for high-risk people. But if you've seen how expensive and unwieldy state risk pools can be, how difficult they are to join (six-month waiting periods, etc.), and the limits to their coverage, you know it's a plan that provides very little for "the least of us." Not only that, but by insisting that these high-risk state plans work with insurers, McCain would ensure even more transfer of public revenue to the private sector.
"Guaranteed access" and the other, more palatable plan provisions are left vague, while the windfall effect for business is immediate and specific. The plan would, in the words of Popeye's pal Wimpy, "gladly pay you Tuesday for a hamburger today."
That's enough to persuade The Politico and other observers that McCain is "moving to the middle on health care." And since politics is a game of expectations, that may be enough. But underneath the centrist rhetoric, the McCain plan will gladly help voters "Tuesday" while it empties out their pockets to give corporate interests a big hamburger today.
Here are some interesting reactions to the plan from across the political spectrum:
Ezra Klein - I particularly enjoyed his "It's 3 AM and your child is sick" opener.
Jonathan Cohn - Perhaps the best overview of the plan I've read.
Race 4 2008 - Review of McCain conference call on the health plan.
Megan McArdle - As she says, the plan is "heavy on theory and light on practice." And in my experience, where a plan is light on practice nothing is going to happen.
Bob Laszewski - Good suggestion about means-testing for that tax break.
Bill Scher - As Bill notes, only a few journalists have written about the radical nature of the McCain Plan.
Joe Paduda - He observes that the McCain plan costs more than either Clinton's or Obama's, but would insure fewer people. Why is that? Because this plan isn't really about health coverage, it's about wealth transfer ... that is, if you judge it for what it does rather than what it says.