McCain on Health Care

Every once in awhile, John McCain reminds you that he remembers what being a Republican used to mean. His plan isn't perfect by any stretch, but it's important because it actually is based on the question of "why are so many without insurance?" The answer of course is that: A. insurance (and healthcare more generally) is exceedingly expensive in this country; and
B. Some percentage of people just don't want insurance almost regardless of the cost.

As Michael Moore's precious World Health Organization study found, the US is tops in the world in quality of care; the reason our overall ranking in terms of quality of system is that: 1. the ranking is biased (by presupposing socialized medicine is better), and, more importantly, 2. the US has ridiculously high overall costs. McCain's plan focuses on those overly high costs; most other plans, including Hillary's and Romney's, focus solely on getting the uninsured insured- in other words, they treat one symptom as if it were the entire disease. Importantly, McCain seems to recognize that much of the cause of high costs in our system isn't too little regulation- it's too much.

In any event, here is what I like about the McCain proposal:
1. Shifting responsibility for some care to nurses (and away from doctors)- if you've ever talked to an experienced nurse at length, you will come to quickly realize that their experience makes them extremely knowledgeable about many medical procedures and diagnoses (often more so than even a doctor who's been around for a few years). Of course, we already have a nursing shortage, but increased workplace freedom for nurses would alleviate this a little bit; additionally, it would increase the amount hospitals are willing to pay their nurses (since they are saving more money on paying slightly fewer MDs).
2. Elimination/reduction of cross-state licensure requirements- this is just common sense (why should medicine be practiced differently in different states); it would only have a minimal effect on costs, probably, but cross-state licensure requirements are just silly to begin with. (I acknowledge there is a federalism concern here, though).
3. Permission for re-importation of drugs from Canada. I acknowledge that this creates problems of intellectual property protections; however, the effect of this will be to ultimately even out drug prices between the US and Canada to reflect a more accurate market value for both (right now, the US insurance market is effectively subsidizing Canadian prescription drugs, as well as prescription drugs in other countries with price controls and universal medicine).
4. Patent reform- I'd like to hear more specifics on this, but our current patent regime is way too restrictive
5. Shifting of tax credits from employers to individuals- I've long said that the employer-based tax credit system creates a perverse set of incentives that results in high overall costs and often inadequate coverage, which effectively pushes overall costs even higher.
6. Elimination of prohibitions against purchase of out of state insurance. Again, there are federalism concerns here, but the wide variations in state insurance coverage requirements are foolish and arbitrary and result in a significant reduction in competition; additionally, this is a legitimate interstate commerce issue.
7. A recognition that a properly functioning market would have competititon for people with pre-existing illnesses, rather than a generalized reluctance to cover such people.

Here is what I don't like:
1. Tort reform- I may just need more details on this, but usually "tort reform" isn't really reform in the proper sense- it usually means creating statutory or bureacratic protections against common law liability. On the other hand, if he means elimination of existing laws and regulations that artificially encourage lawsuits by creating false definitions of standards of care, then I can get on board with this proposal.
2. The one-size-fits all tax credit. I don't know how you can make this more flexible without creating a bureaucratic nightmare, but the size of the credit is massive. While I'm never opposed to significantly reducing the amount the government can take from people, a one size fits all tax credit may amount to a several hundred billion dollar entitlement program unless it is properly implemented.
Areas where I would like to see more details:
1. Encouragement of walk-in clinics at places like Wal-Mart- this is a promising area, but I am generally suspicious whenever the government talks of "encouragement."
2. His Health Savings Account plan- what is the interplay with his tax credit scheme? I am suspicious of his use of the phrase "tax-preferred."
3. Medicare reform- in principle, he is certainly correct about what Medicare should and should not be paying for; however, making this distinction in the real world may mean a choice between arbitrary lines and an even bigger bureacratic mess.

On the whole, McCain's proposal is a logical step forward, and mostly makes sense because it actually begins with a question (to wit: what is wrong with our healthcare system) rather than an assumption (ie, we have too many uninsured people).

I continue to have a difficult time understanding why so many conservatives (especially neo-cons and theo-cons) continue to view McCain as a "RINO." Except for McCain-Feingold (which, by the way, conservative darlings Pres. Bush and Fred Thompson supported) and a couple other notable exceptions, McCain has been a reliable voice for historically conservative positions- maybe even the most reliable such voice in the campaign. For some reason, he is still viewed as being pro-choice (despite a profoundly pro-life record) because of one statement he made in the 2000 campaign that was taken completely out of context and then used by Karl Rove to destroy him in South Carolina.

***UPDATE, 11:59PM*** I foolishly and stupidly forgot to mention McCain's strong support of gun control. However, I don't see how Rudy is any more conservative in this regard. I'm sure there's other issues where he isn't particularly conservative. The immigration issue is one where conservatism has backed further and further away from old-fashioned conservatism, and therefore McCain. But compared to Giuliani or Romney, he's Ronald Reagan reincarnated.