Gas tax stuff aside, I've been remiss in not really dealing with the foolhardy health care plan John McCain put out recently. To my eye, McCain's health care ad looks like a pretty good ad but unfortunately he's mantra that there's no quality problem with American health care is just false. An awful lot of the cost/access problem stems specifically from the fact that we spend a substantial amount of money on useless or counterproductive care. If you could take the resources currently expended in useless or counterproductive ways, and redirect them to useful things, then you'd have plenty of resources available to resolve access issues.

It's too bad McCain doesn't seem to understand this, because it's integral to the rationale behind the conservative notion that we need to shift costs off insurers and on to individuals. I don't agree with that prescription for resolving the quality problem, but the general idea is that if people have more personal responsibility for paying for what they're getting, they'll start holding providers more accountable and quality will rise. As I say, I don't think that's the best solution, but that's the general idea behind shifting risk onto individuals. And this just happens to be at the core of McCain's plan whose "main thrust," as Jon Cohn put it, is "to change the tax treatment of health benefits, which sounds arcane but could actually have far-reaching effects" in terms of unraveling employer-based health care in favor of individual markets.

The downside of this is that people with a history of medical problems (like, um, John McCain, except he'll be insulated from these changes by his job, age, and wealth) won't be able to get decent coverage, which is a pretty bad problem in my view. But McCain doesn't even really seem to know what the justification for this step is supposed to be. Which is too bad, because I really do think a reform-minded conservatism could contribute to improving health care by focusing on regulatory cartels and other drivers of higher costs, but to appreciate those points I think you'd need to have more of a taste for domestic policy than McCain seems able to muster.

Photo by Flickr user soggydan used under a Creative Commons licensE