For all the grandiose promises made in this campaign, has any candidate spoken honestly to the American people about the government's role and failings about individual responsibilities? Has any candidate told the truth about the future of Medicare?
Later, McCain says,
I believe that everyone should get a tax credit of $2500, $5000 for families, if they have health insurance. It is good tax policy to take away the bias toward giving workers benefits instead of wages. It is good health policy to reward having insurance no matter where your policy comes from.
...We should give additional help to those who face particularly expensive care. If it is done right and the additional money is there, insurance companies will compete for these patients - not turn them away. It is a challenge to develop techniques that allocate the right amount to each of these families. I propose that we try a time-honored approach and let the states work on whatever method they find most promising. The federal government can help fund this effort, but in exchange, states should allow Medicaid and SCHIP funds to be used for private insurance and develop methods to augment Medicaid and tax credits for more expensive care.
I like what he says as far as it goes. But his solution for Medicare is the unproven remedy of Pay for Performance (he does not use that term). I am sure that just about every candidate will endorse P4P, because it sounds like a sort of free lunch--pay for care that is necessary, don't pay for care that is unnecessary, and save lots of money. The problem is that we only have a few examples of procedures that we know are not done enough and a few examples of those we know are done too much. We need a lot more information to make P4P work, and even then I am skeptical.
I think that we have to tell young people, honestly, that we cannot promise the degree of Medicare coverage that today's seniors enjoy. Young people need to start saving now.
Overall, McCain's speech is an improvement over what he rightly criticizes as the "bidding war" approach to health policy.