Bravo, Mr McCain

The presumptive Republican nominee (I wonder when that phrase will get old) revealed a more in-depth look at his plan for healthcare yesterday, highlighting its market-based approach and fairly comprehensive incentives. It looks lean compared to the messy propositions of Democratic rivals Hillary Clinton and Barack Obama. But healthcare is traditionally a battleground between ethics and pragmatism, where the populists will invoke the children and the elderly and it then becomes about doing the "right thing" versus the "corporate thing."

It is one of those areas in American politics that is hard to touch because it is so emotional yet absolutely impractical to leave in its current state. In the end it is about money: a middle class increasingly unable to afford ballooning medical bills (exacerbated by obesity, diabetes, and cancer) and the elderly under a Medicare plan thousands of pages long and not even in actuarial balance. That Mrs Clinton or Mr Obama could propose their government could do an significantly more efficient job of keeping costs down for 100% of Americans seems unrealistic.

Because cost is the problem for Americans it is logical that costs should be examined and addressed by their own merit, not behind the veil of an ethical crusade for the "right" thing. Mrs Clinton and Mr Obama seem to think that this is one aspect in which we can genuinely reach utopia.

Mr McCain proposes a more pragmatic albeit imperfect plan. But pragmatism and results are something that can be shaped and created with, unlike utopia. He advocated individual, tax-friendly Health Savings Accounts, as well as tax credits of up to $5,000 for the purchase of individual insurance. His strong point is his emphasis in the important shift away from employer-provided insurance that ties workers to the bureaucracy of their companies and can leave them unnecessarily helpless in interim periods. It is not entirely logical that this insurance structure even exists in the USA today; the Anglo-American business model is heavily oriented toward labor volatility.

There are some big holes in McCain's plan, though. His reliance on individual rather than employer-based insurers is one of his strong suits, but it also opens the pandora's box of medical underwriting. Most any Republican would be hesitant to slap underwriting legislation on insurance companies, and McCain proposes a state-focused solution that brings in non-profits, often in the setup of "high risk pools." These have not proven promising in the past and there is no reason to believe that their coffers would be adequately filled to provide a consistent level of care.

The notions of Mrs Clinton and Mr Obama are noble ones. But they are not realistic in the next four or eight years, and governments the world over (including this one) have proven absolutely incapable of managing the tremendous cost of universal health care. The government must provide a safety net for those who fall through the cracks of a tempered market system. But spare me, Mrs Clinton, and stop invoking "the kids."