Senator John McCain (R-Ariz.) doesn't think there should be a mandate to have health insurance. “I think one of our goals should be that every American own their own home, but I'm not going to mandate that. … I feel the same way about health care. If it's affordable and available, then it seems to me it's a matter of choice amongst Americans,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.
“The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses or preexisting conditions do have problems accessing insurance, “and we have to make special provisions for them.”
Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “I'm not going to force Americans to do it; I don't think that's the role of government,” he said. “But if we can bring down costs, as I believe we can … I'm absolutely convinced more and more people will take advantage of [insurance]. The panacea isn't all just health care costs, but unless you address health care costs, you're never going to solve the other aspects of the health care crisis.”
One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should be paying the provider and the doctor a certain set amount of money directly related to overall care and results. That way we remove the incentives now in place for overmedicating, overtaxing, and overindulging in unnecessary procedures. I also think it rewards good performance by the providers.”
Sen. McCain proposes a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance. To pay for the credits—which would cost an estimated $3.5 trillion over 10 years—he proposes abolishing the tax deduction employees take when they pay premiums on their employer-sponsored health plans. He would leave intact the deduction employers take on their portion of the premiums as an incentive for employers to continue offering coverage.
The “refundable tax credit for employees [allows] them to go out and make choices,” Sen. McCain said. “When it's their money and their decision, I think they make much wiser decisions than when it's provided by somebody else.” Low-income Americans who pay no taxes will receive a check for the amount of the credit, he noted.
When a reporter pointed out that the average cost for family health insurance is more than $12,000 per year—far higher than the amount of the proposed family tax credit—Sen. McCain said the credit still would be beneficial. “If someone has a gold-plated health insurance policy, they'll start to pay taxes [on those premiums] and it may make them make different decisions about the extent and coverage of their health insurance plan,” he said. Additionally, “For low-income people who have no health insurance today, at least now they've got $2,500, or $5,000 in the case of a family, to go out and at least start beginning to have [it].”
Sen. McCain admitted the tax credit plan “is not a perfect solution, and if not for the price tag involved, I'd make it even higher. But according to the Congressional Budget Office, by shifting the employee tax aspect of it, you save $3.5 trillion over a 10-year period, and I think that would have some beneficial effect at reducing the overall health care cost burden that we're laying on future generations.”
Sen. McCain said he does not support outlawing the “cherry-picking” that some health plans do to make certain they insure mostly healthy people. Outlawing cherry-picking “would be mandating what the free enterprise system does.” Instead, he favored broadening the high-risk pools that states use to provide coverage for some of their uninsured residents. “I would rather go that route than mandate that health insurance companies under any condition would have to accept a certain level of patients. … One reason is that we have seen in the past that [insurance companies] have a great ability to game the system.”