Politically, Plan McCain may be suicide. Clinton and Obama have kept to the current employer-based system -- which gives workers the happy illusion of not paying for their health care, when in fact it comes out of their paychecks.
Like President Bush, however, McCain has concluded that the best way to curb health care costs is to return the incentive to save to patients. Because when you know a doctor's visit will only cost $25 and that you won't have to pay for a test you may not need, you have no incentive to economize. That's the problem with the status quo: The cheaper we make it look, the more it ends up costing.
The way Americans look at health care has been distorted by a system that cuts costs where they are least onerous. Gone is the day when patients paid for annual medical exams and insurers picked up the tab if a family member became seriously ill. Now you don't have to be sick to be subsidized, and workers have come to expect someone else to pick up the tab for routine care, minus a modest co-pay.
Credit McCain for proposing to make the process transparent, so that people have a more personal stake in the care they receive. To the extent that adults buy their own policies, they will be free to work wherever they choose, and they will no longer be bound by their health care.
Also, just maybe instead of scorning what comes cheap, Americans will come to appreciate what they pay for.
When I hear middle-class Americans complain about how they want Washington to do something to pick up their health tab, I always want to ask them: If you don't want to pay for your own health care, what makes you think someone else wants to pay your doctor bill?