Monday, April 28, 2008

McCain just won my wife's vote

My wife is pretty much a single-issue voter this year. As a physician who owns her own practice and already despises the extent to which the government has intruded itself into her business, she's reserving her vote for the major-party candidate who promises the least expansion of the state sector in medicine. So, while we haven't discussed the latest development yet, I think this announcement will clinch it for her:

Sen. John McCain on Monday rejected a "big government" takeover of the health care system, saying he wants to empower families to make more medical decisions.

"I've made it very clear that what I want is for families to make decisions about their health care, not government, and that's the fundamental difference between myself and Sen. Obama and Sen. Clinton," McCain told reporters in Miami, Florida, referring to the two remaining Democratic presidential candidates, Sens. Hillary Clinton and Barack Obama.

"They want the government to make the decisions, I want the families to make decisions," he said.

But, McCain goes on to denounce "parochial interests" in medicine and said:

"We must move away from a system that is fragmented and pays for expensive procedures, toward one where a family has a medical home, providers coordinate their efforts and take advantage of technology to do so cheaply, and where the focus is on affordable quality outcomes."

That doesn't really sound to me like a candidate who wants to get the government out of the way and let the market provide medical care in a variety of ways to consumers with different needs -- free markets are, pretty much by definition, "fragmented" -- so I'm not sure what his assurances are worth.

But with Hillary Clinton and Barack Obama promising to stick the insurance companies with the cost of government-designed coverage (until they close their doors) that (under Hillary's plan) everybody is forced to sign up for, basically denying people access to low-cost, bare-bones plans, McCain sounds at least a bit less dangerous. And that's before we even get to the Democrats' vow to limit drug companies' prices and profits, pretty much eliminating the incentive to incur the $802 million cost of developing and getting approved a new drug or the $1.2 billion cost of developing and winning approval for a new biotech product.

I still think that to whatever extent McCain is more market-oriented than his donkey-party rivals, it's more by default than by conviction -- he wants to distinguish himself from the competition, and Republicans can't really go more socialist than Democrats. On his own, though, he's generally distrustful of the free market, and convinced that the government needs to intervene and throw its elbows around. His prescriptive vision for health care, revealed above, sounds to me like a military man's gut-level instinct to address a perceived problem by issuing orders from above rather than by getting out of the way and letting people work out grassroots-level solutions -- probably a multitude of solutions to address many needs and preferences.

I think, then, that McCain's instinct is to move in the same coercive direction as Clinton and Obama, with the right solution (whatever in hell that is) imposed from the top down, but less so, just because he's a Republican.

That'll probably be enough for a lot of voters (including my wonderful wife), but a slower road to a bad destination doesn't sound too enticing to me.

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