Tuesday, June 12, 2007

McCain to Propose a Health Care Reform Plan--Both Democrats and Republicans Becoming Predictable on Health Care

Republican presidential candidate Senator John McCain said this weekend that he is working on a health care reform proposal. He gave no time for its release but did mention a number of components:
  • His plan will not include tax increases.
  • It will not include any coverage mandates--presumably individual or employer mandates.
  • He would make greater use of health care information technology.
  • It will expand on the current State Children's Health Insurance Program (S-CHIP).
  • It will include greater emphasis on individual responsibility and will include the use of health savings accounts (HSAs).
  • It will include medical malpractice reform.
While short on details at this early stage, McCain's health reform plan would appear to follow the usual conservative Republican philosophy of more individual responsibility and the use of market forces.

It would also appear that McCain's proposal will be very similar to the preliminary information we have seen on Rudy Giuliani's forthcoming health care reform proposal.

Both the leading Democratic and Republican presidential candidates appear to be falling in line along predictable policy outlines.

Generally, Democrats are emphasizing more comprehensive and expensive plans that look a lot like the recently enacted Massachusetts plan--with costly expansions of existing public and private plans and requirements that individuals and/or employers pay for coverage. Many Democrats see the bigger health insurance pools, like employer plans and traditional Medicare, as the best way to deliver affordable and comprehensive benefits.

Republicans, on the other hand, generally favor more individual responsibility, a more transparent market, and a movement away from the traditional, and generous, employer-provided health care that many Republicans believe have helped push health care costs higher. Many conservative Republicans believe employer plans have insulated consumers so much that the usual market forces have been lost in health care and that the private markets should also be brought to bear to bring Medicare and Medicaid costs under control.

During the primary season at least, health care doesn't look to be a deciding issue. Simply, the leading Democrats all look to have similar health care proposals--no real opportunity to differentiate candidates there. Now, it appears that at least two of the leading Republicans--McCain and Giuliani--will also have indistinguishable health care proposals.

However, Republican presidential candidate Mitt Romney has yet to tell us what his health care platform will look like. Romney is presenting himself as a conservative Republican but, as the recent Governor of Massachusetts, has signed the Massachusetts health reform law that has become the baseline for the leading Democratic candidates' health care reform proposals.

Now what will Romney do? Will he move in the direction of the Democratic Massachusetts-like proposals or will he move away from his own legacy and away from Massachusetts? I wouldn't bet on this self-described conservative offering anything like the Massachusetts-style plans we have seen the Democrats propose.

Presuming no surprises from Romney, there will be little on health care to differentiate the front-runners in either party from their leading rivals during the primary season.

But, come the general election, there will likely be a clear choice on health care. From what we have seen so far, Clinton, Edwards, and Obama all have proposals dramatically different than what we will see from McCain and Giuliani--and likely Romney.

Come November on health care, the choice will likely be very clear.


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