Michael Gerson

WASHINGTON -- It is a shame that a discussion of health care policy has come near the end of the presidential campaign, when the level of discourse is at its lowest.

In the midst of assailing John McCain's mental health -- he is diagnosed as both "erratic" and "out of touch" -- Barack Obama and Joe Biden have pressed an attack on McCain's health care plan that is deceptive in almost every detail.

McCain has proposed to replace the current government health care subsidy for employers with a tax credit that would help all individuals and families purchase coverage. Biden terms this the "largest tax increase in the history of America for the middle class." He is off by -- well, by even more than the norm of Biden hyperbole. In fact, the McCain trade-off would result in a significant tax cut for nearly everyone (except those with the highest incomes).

Obama breathlessly reveals that the McCain credit "wouldn't go to you. It would go directly to your insurance company." Since the credit is intended for the purchase of health insurance, where else should it eventually go? Is it a scandal that a child care credit eventually goes to child care centers?

"At least 20 million Americans," charges Obama, "will lose the insurance they rely on from their workplace." As Yuval Levin of the Ethics and Public Policy Center points out, this is a distortion. He cites a Tax Policy Center estimate that the McCain plan would result in 21 million people entering the individual insurance market by 2018 -- many because individual ownership of insurance will be more attractive. In every mainstream analysis, McCain's plan would result in a net increase in the number of the insured.

Obama terms the McCain plan "radical" -- which is its main virtue. It goes to the root of the problem -- a system that depends mainly on businesses to provide health coverage. Over the last few decades, the rising cost of health coverage to employers has eaten up pay increases, acting as a wage cap and leaving many incomes stagnant or falling. Business-based health coverage leaves many workers afraid to change jobs -- a handicap in the constant employment churn of the new economy. It discriminates against the self-employed and places unique burdens on small businesses. And it insulates workers from decisions about health care costs. Few in the current system benefit from searching out the best health care prices and results.

Michael Gerson

Michael Gerson writes a twice-weekly column for The Post on issues that include politics, global health, development, religion and foreign policy. Michael Gerson is the author of the book "Heroic Conservatism" and a contributor to Newsweek magazine.
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