Plumber's Butt

I have made essentially these same arguments here, but you don't have to take it from me, a mere hippiecommiegodlessfreakblogger, when you can take it from David Blumenthal, M.D., M.P.P., Director, Institute for Health Policy, Massachusetts General Hospital.

John McCain emerges not as a maverick or centrist but as a radical social conservative firmly in the grip of the ideology that animates the domestic policies of President George W. Bush. The central purpose of President Bush's health policy, and John McCain's, is to reduce the role of insurance and make Americans pay a larger part of their health care bills out of pocket. Their embrace of market forces, fierce antagonism toward government, and determination to force individuals to have more "skin in the game" are overriding — all other goals are subsidiary. Indeed, the Republican commitment to market-oriented reforms is so strong that, to attain their vision, Bush and McCain seem willing to take huge risks with the efficiency, equity, and stability of our health care system.

The true facts about the way health insurance markets work are very difficult to explain in the 30 seconds that candidates get to put across an idea in a debate, and they certainly don't fit on a bumper sticker. If that were not the case, McCain's bamboozlement on this issue would have long ago utterly destroyed his candidacy. But let me try one more time to get the bullet points to a manageable, comprehensible few.

1. In deregulated, private insurance markets, insurance companies will either charge a lot more to people who are sick or are at risk for getting sick; or they won't sell insurance to those people at all.


2. In deregulated, private insurance markets, insurance companies will do everything they can not to pay claims.


3. If you make people pay more out of pocket for their health care, they won't end up reducing costs by making wise choices about expenditure, because the vast majority of medical spending is already for serious needs, i.e. stuff like cancer treatment and heart surgery. What people will scrimp on is stuff like screening and preventive care, which will just make us sicker and cost more in the long run; while people who do get sick will end up being punished for it financially.


4. John McCain's health care "reform" proposal will make it impossible for older people or people with chronic diseases to get health insurance; will make the insurance that people can buy less comprehensive; and will increase administrative costs and waste.


5. It will mean fewer people have insurance, people with the greatest need will get the least and people with serious illnesses won't be able to get treatment at all, so they'll just die. It will be the law of the jungle.


6. John McCain is a radical extremist who does not share the values of most Americans.

Those are the facts. Let's see if CBS will report them.