9-28-08, 9:25 am

When politicians start to bandy about buzzwords, you know we're in trouble. And when it's McCain talking about health care and the buzzwords are 'consumer choice' and 'competition,' that trouble is deep, very, very deep. In a nutshell, McCain's plan, a dusted-off interpretation of Bush's proposals, rests on three key provisions: ending the tax exclusion for employer-provided insurance (i.e. taxing workers' health care benefits), creating a health insurance tax credit of $2500, and effectively deregulating the health insurance industry (by pushing people to buy individual insurance across state lines).

McCain's plan has three main likely outcomes, over a few years: a dramatic increase in the number of uninsured as employers drop this benefit and/or lower-wage workers cannot afford it, higher insurance costs for those who seek individual coverage and less coverage for those who manage to remain insured. These consequences flow directly from what will become an insurance industry run wild.

Let's take a look at a few of these details. First, taxing health benefits is said to be more fair, since higher wage workers, in higher tax brackets, save more and, beside, workers will be more aware of how much their employers are paying for this (as if their constant reminders are not sufficiently clear). In fact, it is estimated that when employers lose this incentive to provide coverage, easily 17 percent fewer workers will even be offered health insurance on the job. Add to this those who won't be able to afford the benefit once it's taxed.

Second, McCain proposes a tax credit of $2500 for those who buy their own insurance in his new, competitive market, $5000 for a family. That sure isn't much when you look at premiums of easily $1000 per month for decent coverage in the non-group market. Compared to group plans, these often have higher deductibles (about $2750 vs. $1000) and higher co-pays ($30 to $40), and cover fewer services. Finally, perhaps the most pernicious detail is the encouragement of 'competition' by 'allowing' people to buy health insurance across state lines. This effectively eliminates state regulations such as minimum coverage and consumer protections.

What would be lost as insurance companies locate in states with the most lax regulations? Not all states require insurance companies to cover cervical cancer screening and breast cancer reconstructive surgery, demand mental health parity or cap rates for 'higher-cost consumers' (i.e. sick people).

A look at McCain's health care package brings to mind the glorious Medicare prescription drug benefit, another program that promised the sun, moon, and stars and delivered a donut. Only in the Bush and McCain world is it a good idea to get rid of the quantity discount.

As employers are wooed (and pushed) away from providing health care insurance to their employees, as group insurance is undermined and disappears from the scene, all the advantages of scale ... lower cost, clout in negotiating with powerful insurance corporations ... are lost. Your employer might not be cutting the best deal in the world right now, but imagine trying to negotiate with Humana, Blue Cross, or Aetna or on your own – in an unregulated market! How convenient for McCain's new and improved insurance industry!

While it is arguably true that health care should not be tied to employment, until we, as a nation, are ready to embrace health care as a fundamental right and provide it to all, ripping apart the means to access of the majority of workers is simply not a solution to the crisis. We cannot let this man anywhere near our health care or other employee protections or services, such as the right to organize or paid vacations; imagine what damage he would wreak with existing entitlements, such as social security and public education!

It is hard to imagine anything more cynical than McCain claiming this is all for the sake of cost containment and quality. We cannot afford four more years.

For more information, see 'Experts Critique McCain and Obama Health Plans,' Health Affairs, press release, September 16, 2008; 'Cost and Coverage Implications of the McCain Plan to Restructure Health Insurance,' by Thomas Buchmueller, et al, Health Affairs, September 16, 2008; ',' by Jonathan Oberlander, The New England Journal of Medicine, August 21, 2008; '2008 Presidential Candidate Health Care Proposals: Side by Side Summary,' The Henry J Kaiser Family Health Foundation, Health08.org.

--Annie Fox is co-health editor of Political Affairs. David Lawrence, co-health editor of Political Affairs, contributed to this article.