Don't Dare Call It A Plan

What is Giuliani's health care plan, and how does it differ from what other Republicans will propose? It's hard to say. Giuliani has previously called for a $15K-per-family health deduction and an expansion of health savings accounts, but his speech tomorrow will be less of a detailed plan and more of a statement of principles. In fact, Giuliani doesn't seem to like the word "plan" because it suggests a one-size-fits all approach.

His health care advisers broadly sketched the outlines on a conference call closely monitored by Giuliani's campaign manager, Mike DuHaime.

Giuliani wants to control health care costs by reducing the distance between health care decisions and those who pay for them -- what one of his advisers called "value based purchasing decisions." The federal government's role would be to provide incentives to states to, well, it's not clear. Giuliani opposes state insurance mandates like the one Mitt Romney signed into law in Massachusetts. The overall goal -- the way to make sure people can pay their medical bills -- is a process for "a better set of insurnace products that would match the needs" of the market, Goldsmith said. No individual mandates, then, and moving away from employer mandates.

ABC's Jake Tapper wondered whether there was anything in the proposal that big Insurance or big PhRMA would find objectionable.

Goldsmith started to answer, but DuHaime cut him off saying that Giuliani might want to answer that one.

"Ok, I can take that hint," Goldsmith said. We'll put that off."

Not asked or answered was why Giuliani believes that a less fettered free market approach to health care would reduce costs, or what degree of market freedom would be required to achieve the savings, or how the market should be contoured or incentivized to handle that type of medical care that is inherently profitless. Also unclear is why Giuliani views health care as a commodity: People get older and want the latest test or the best treatment. Perhaps they might demand less if they knew they're responsible for more of the cost...sort of a health care Pigout movement... but social and economic engineering on this scale is daunting.

Ezra Klein? Brad DeLong?