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You Want Domestic Policy?

John McCain is trying his best to shift from his single-minded focus on foreign policy to a broader agenda that will appeal to key independent voters. His topic this week is health care, about which he offered a detailed speech and a new ad.

His approach borrows from George W. Bush’s ill-fated healthcare plan (and from Rudy Giuliani’s as well). The basic idea is to shift from employer-based plans (in which the consumer/patient is not responsible for costs) to individually-purchased healthcare plans (where consumers will be in charge). By ending the employer benefit tax exemption and providing a tax credit instead, allowing interstate insurance purchases, and throwing in some tort reform, this proposal aims to decrease cost and increase availability.

But McCain has a ways to go if he’s going to sell it. One troubling aspect of the proposal, his GAP plan, is in bad shape. It’s aimed at a vaguely defined pool of hard-to-insure and needy healthcare consumers, and it sounds like little more than an adjunct to Medicare and Medicaid. McCain says:

I will work with Congress, the governors, and industry to make sure that it is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs. These programs reach out to people who are at risk for different diseases and chronic conditions and provide them with nurse care managers to make sure they receive the proper care and avoid unnecessary treatments and emergency room visits. The details of a Guaranteed Access Plan will be worked out with the collaboration and consent of the states.

Although he disclaims any intention to create a new entitlement program, he says that the GAP plan would put “reasonable limits on premiums, and assistance would be available for Americans below a certain income level.” That said, McCain’s plan is as market-based an approach as a politician who doesn’t want to risk running on a platform of “Buy your own darn insurance!” is going to offer