JOHN MCCAIN pretended last week to treat health insurance, an essential of modern life, as something that could be relegated to the marketplace and individual choice. A robust government role, however, is a precondition to extend coverage to the 47 million Americans who are without it. The market alone cannot achieve that result.
Yet the near-certain Republican nominee for president derided the specter of federal intervention. "In the end this will accomplish one thing only," he predicted in a speech in Tampa. "We will replace the inefficiency, irrationality, and uncontrolled costs of the current system with the inefficiency, irrationality, and uncontrolled costs of a government monopoly." Never mind that Medicare is justly popular for effectively providing medical coverage to elderly Americans for more than 40 years.
McCain would treat the health insurance provided by employers as taxable income for their workers. To offset the higher tax bills, he would offer credits - $2,500 for an individual, $5,000 for families. Yet last year comprehensive coverage cost $4,479 for individuals and $12,106 for families, according to the Kaiser Family Foundation. Many people would have to pay higher taxes to get the insurance they want.
McCain's alternative is greater use of health savings accounts, which trade lower premiums for a high deductible. Under this scheme, people are expected to pay for routine care without relying on insurance. The US Government Accountability Office reported last week that the average income of people with HSAs was $139,000 in 2005. Affluent people may appreciate the tax advantages and don't mind out-of-pocket payments, but most people appreciate the financial security of a comprehensive plan.
That would especially include those who are close to retirement age or have chronic conditions, yet many cannot afford individual policies. (The Massachusetts health reform law does offer coverage for them, but policies are costly for older people.)
McCain promises to work with the states to get these people some sort of insurance, but he offers no details. Medicare effectively covers the elderly and disabled by using a combination of premiums and tax revenues. That proven solution has no place in the orthodoxy of free-market Republicanism.
"The goal, after all, is make the best care available for everyone," McCain said in his speech.
If the free market could have met this challenge, it would already have done so. Senators Hillary Clinton and Barack Obama have suggested stronger government intervention and more tax money to cover the uninsured. That's a better way to reach McCain's laudable intention.
