John McCain and health care: conventional conservative views with a couple of interesting twists

Senator McCain, we will miss you

I mourn with the nation on the loss of Senator John McCain, an American patriot and public servant. Plenty of retrospectives are appearing on McCain just now; naturally I’ll focus mine on healthcare.

Back in 2008 I profiled the major candidates on healthcare policy, comparing Obama to McCain and calling out my favorite on each main area. In three posts, I examined the candidates’ positions on individual and employer mandates, expansion of public programspremium subsidies and tax law changes.

McCain never really made healthcare a centerpiece of his campaign, and I don’t think he was especially passionate about it. The policies he put forward were fairly mainstream GOP ideas of the day –modest in scope and likely to be modest in impact as well. He opposed an individual or employer mandate to purchase health insurance, and took no position on the expansion or cutback of government healthcare programs like Medicare and Medicaid. He was in favor of allowing veterans to use their VA benefits in the name of obtaining convenient, high quality care outside the VA system.

McCain proposed modest tax credits, and even some extra boost for people with pre-existing conditions. The math never added up on these and the impact would not have been great.

John McCain’s most radical proposal is one I generally agree with: eliminating the tax deductibility of employer-sponsored health insurance. McCain would have taxed these benefits as income, which they are. If implemented as proposed, this provision could have driven down the availability of employer sponsored health insurance without replacing it with anything; that would not have been a great outcome. More likely, a compromise version would have passed, essentially placing a cap on deductibility without scaring employers away from offering coverage.

This policy is not so dissimilar from the so-called Cadillac tax in the Affordable Care Act, which is hated by just about everyone. Nonetheless it’s good policy because it puts the brakes on insurance costs and encourages employees to value their benefits rather than take them for granted.

Looking back on these posts a decade later, it’s also interesting to see how pragmatic Obama’s proposals were. For example, Obama focused his attention on universal coverage for children, encouraging businesses to offer health insurance to their employees. He also called for creation of a public plan modeled on the Federal Employee Health Benefits Plan, to help individuals that couldn’t find good plans elsewhere.

Rest in peace, Senator McCain.

By healthcare business consultant David E. Williams, president of Health Business Group.

August 27, 2018

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