Your Health Care May Decide the 2008 Election

Now we're in the presidential campaign's silly season. The primaries are over; the conventions are yet to come. Americans are tuning out politics and dialing in baseball, the Olympics, vacations and the price of gas.

Barack Obama is traveling abroad, demonstrating that he really is a responsible driver. And John McCain seems intent on running into every pothole in the road. This week, he published an op-ed in the New York Post slamming Obama for agreeing with the Iraqi prime minister that the troops should be brought home by 2010. Sure, McCain admitted, "Iraq's army will be equipped and trained by the middle of next year," but it will still need a lot of help. "The Iraqi air force, for one, still lags behind, and no modern army can operate without air cover." Particularly not against the fearsome al Qaeda air force. And McCain didn't even mention the need to build Iraq a blue-water navy. The $3 trillion that Nobel Laureate Joe Stiglitz estimates we've squandered on the war -- about a billion a day in direct and indirect costs -- isn't nearly enough.

Americans will begin to tune in to the election again around the conventions. And in the fall, they'll start to take a closer look at who the candidates are and what they believe. Issues matter less in this assessment than broad measures of the candidate's character and sense about whether he has a clue.

In this assessment, I suspect that one issue, seldom mentioned now, is going to matter a great deal by November. Iraq will be big, no doubt; the economy bigger. But health care may just be the pothole that cracks up McCain's Straight Talk express.

People worry a lot about affording health care. Workers accept lower wages with employers that offer health care. They hang onto lousy jobs to keep their health care. Most labor negotiations and disputes center largely on the costs of health care. On this issue, attention is paid over kitchen tables across the country.

So this fall, Americans will discover an inconvenient truth about John McCain: He wants you to lose your employer-based health care. He thinks you aren't sufficiently conscious about the cost of your health care, and you are using too much of it.

His plan is designed -- with sugar and sticks -- to push you to negotiate on your own with the friendly insurance companies. He'll give you a tax credit -- $2,500 for an individual; $5,000 for a family -- to help you pay the price. And he'll revoke the tax exemption for any health benefits your employer provides. Under his plan, those benefits will be taxed as income. McCain says this will reduce our health care expenditures. He might be right. His preferred option -- health saving accounts -- generally features low monthly payments and very high deductibles. People tend to insure themselves against catastrophe and take a chance on routine health care.

On average, this will work pretty well if you are young and healthy and lucky. But if you are sick, if you have suffered serious illnesses in the past, if you have what insurers call a "pre-existing condition," or if you are older and at higher risk, you're in trouble. For many, insurance won't be available at any price. That's why Elizabeth Edwards noted that neither she nor McCain would be eligible for such coverage since both have struggled with cancer. Many more will find adequate coverage unaffordable. Others will have to choose between paying to see a doctor or buying the weekly groceries. You'll be more "sensitive to price," but you might not think that a good thing.

McCain extols the benefits of private health insurance, but he's never had to negotiate with insurance companies. He's been on government-provided health care virtually his entire life. He was raised on military health care, as the son of an admiral. He then went to the Naval Academy and to the military. A year after leaving the military, he was headed to the Congress and enjoying the best government-supplied health care of all.