What was most notable about presumptive Republican nominee John McCain's health care plan unveiled Tuesday was the campaign's unrealistic assessment of its impact on people with life-threatening conditions like cancer, the millions of Americans with chronic disease like diabetics, or preventive care. Instead of promising to expand insurance, as the Democrats are offering, McCain fully embraced the individual private insurance model cooked up by conservative think tanks overly enamored of free market medicine, which no place on earth other than the U.S. takes seriously.

Like President Bush's proposal which the Democratic Congress dismissed out-of-hand, the McCain plan would end the federal subsidy to employers for providing health insurance and give it as a tax credit to individuals ($2,500) and families ($5,000). This is about half what a family plan costs today, leaving the average family of four needing to pay around $400 a month for coverage comparable to what they now have.

You don't have to be a rocket scientist to see that in today's economy, many relatively healthy families who are currently uninsured will choose to underinsure, buying plans without first dollar coverage (whoops, there goes preventive care), with high deductibles and co-pays for routine care (huge extra bills for people with chronic disease), and that limit coverage for expensive cancer drugs (the so-called Tier 4 drugs) and put a cap on total coverage.

The plans authors claimed many employers would continue to provide insurance to retain their best employees. Don't they believe their own free market rhetoric? By removing the tax break, they would create a powerful incentive for even the most well-heeled companies to cap their health care expenses by offering flat payments in addition to the government credit. Over time, as health care costs continued to rise, more and more Americans through their individual choices would find themselves in the chronically underinsured pool.

McCain's answer to the uninsured and underinsured that his plan would leave behind is a new health care welfare system. Er, I mean a safety net. The campaign would create a federal-state program (capped, he reserved his strongest language for his refusal to create an unfunded mandate) that paid for uncompensated care delivered at hospitals. According to the New York Times, McCain's top domestic policy adviser, Douglas Holtz-Eakin, estimated the federal share would be about $7 billion and $10 billion.

I doubt that estimate would fly at the Congressional Budget Office that Holtz-Eakin used to run. With 47 million uninsured, with millions of people already underinsured because of the inadequacies in their employer-provided plans, and with millions more choosing to become underinsured because of the inadequacy of the tax credits offered in McCain's plan, can he really think the federal portion of the safety net will amount to just one-half of one percent of our annual health care bill?

If they actually capped it at $10 billion, that wouldn't be a safety net. That would be Swiss cheese in a sandwich without bread, lettuce or meat.