We've got a situation now where firms like Wall Street investment bank Goldman Sachs, former employer of our current Treasury Secretary Hank Paulson, offers sex change operations as part of their tax-sheltered health care plan.

David Gratzer of the Manhattan Institute points out that the individual out-of-pocket portion of health expenditures dropped from 42 percent in 1960 to 14 percent in 2002. Over the same period, as individuals became increasingly divorced from their own health care realities, per capita health care spending more than quintupled.

Sens. Hillary Clinton and Barrack Obama can't grasp that our perverse health care economics result from over-centralization and bureaucratization, so they propose even more. They put more responsibility on employers and give government an even stronger role to define what health care is and how much it should cost. They propose to lower costs through subsidies financed by massive tax increases.

McCain's approach will use markets and consumer power to drive down costs and open the door to innovation in health care products and delivery.

One such innovation of recent years has been health savings accounts. America's Health Insurance Plans has just reported that the number of these accounts has increased 35 percent over last year. This impressive growth came without the more attractive tax treatment that would be afforded such plans under McCain's proposal. The fastest growing market for health savings accounts are small businesses.

In a just released poll by the Kaiser Family Foundation, 44 percent said they'd like to see health care reform moving to individuals making their own purchases, while 43 percent preferred building on the current employer system. Democrats prefer the employer system and Republicans favor individual purchases. Interestingly, Independents favored individual purchases to the employer system, 49 percent to 41 percent.

Difficult issues remain, such as how to deal with those currently uninsured and with pre-existing conditions.

But John McCain has gotten this debate off on the right note. If voters can rise to his standard of boldness and courage, we will make important improvements in American health care.