The health-care debate you ought to hear

Pat Regnier's column "The Bottom line," appears monthly in Money Magazine. Email him at pregnier@moneymail.com

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(Money Magazine) -- The presidential candidates' health-care-reform plans talk about things you want, like choice and affordability. They're mostly silent on what you might lose. As I write this, we don't know who the Republican and Democratic nominees will be, but since the candidates pretty much adhere to their party lines, it's easy to imagine how a health-care debate would play on TV. But if we could slip a little truth serum into their water glasses...

Is there anything you agree on?

The Democrat: It's ludicrous that your health insurance is tied to your employer. Why should you lose your insurance when you lose your job?

The Republican: I'll second that.

Okay, so what would you do about it?

R: Fewer companies should offer health insurance, and it should cover less.

You know we're on national television.

R: I'm just feeling especially expansive tonight. We want you to feel the pain of paying for health care, so you'll shop around more and, we hope, spend less. And maybe you'll lay off the Krispy Kremes too. So first we're going to give you a tax break to buy insurance by yourself, not just when you get it at work, as is the case now. Do that and some employers already on the bubble about whether to offer benefits may opt to just pay highly valued employees extra cash. If you're lower down the ladder or in poor health, you might lose out. But we think the tax break could help many more uninsured afford coverage.

You may well end up in a plan with higher deductibles, more co-payments or more restrictions. But we'll also expand tax-deductible health savings accounts to pay for out-of-pocket expenses. Bonus: They're a great retirement tax shelter for our favorite people, the wealthy.

D: Remind me to quote you on the "pain" part in my next ad.

You Democrats want a universal government insurance program like the one in Canada, right?

D: In my dreams. That's a giant political loser for us. So we're going to try to do the same thing, except that we'll have much of the money pass through the hands of private insurers and employers. Your company will have to cover you or contribute to your pick of government-approved plans; we'll cap or subsidize some premiums. There will be private plans but also a Medicare-like plan that my left flank hopes will grow into something more, well, Canadian.

Look, universal health care is expensive. So we hide costs all over the system. That way Republicans can't accuse us of plotting a massive tax hike.

R: You know, we have ad guys too.

Am I going to have choices?

R: All the choice a free market can give you. We don't want lots of rules telling you or an insurer what a plan should cover or cost. Of course, if you have less income, you'll have fewer choices. And if you have health problems, you may find that your money isn't green enough to buy a policy without government help.

D: If we win, you'll choose among plans with lots of coverage maybe more than you actually want. We may even make you buy insurance. We can't afford to have young, healthy people opting out of the system or buying bare-bones plans. We need them subsidizing the sick for our ideas to work.

What's the biggest flaw in your plan?

R: If you're one of the 45 million who have no insurance now, there's a good chance you still won't have any under our plan. We have ideas for helping people who can't afford or find coverage, but we don't want to spend a lot of federal money, so we'll probably push the problem down to the states.

D: We're creating a huge new entitlement. But we don't really know if the improved efficiency and preventive care we like to talk about will go far enough in containing costs. Every dollar we might save is one lost to the health-care industry. They'll fight us for every nickel.

Thanks for the candor. Now let's move on to our next subject: taxes. Can someone bring us another pitcher of water?