If you're an entrepreneur, freelance whatever, writer, blogger, young, whateverer, you should take a minute to consider the appeal of McCain's healthcare proposal. McCain wants to eliminate tax deductions for worker-sponsored health insurance, and then offer a tax break for one's own health care expenditures. Obama has called that a tax hike, and it seems that slamming McCain's health insurance plan will be a key part of his closing argument.
But you should stop and think what this is all about: It's about unmooring healthcare and stable employment. For a lot of folks, employee-sponsored health insurance is a key aspect of career choices. Because it's so difficult to buy health care on the open market, a steady boring job at a large firm is a necessity -- you might want to drop out of that, do a startup, be a filmmaker, an artist, travel for 6 months, etc., but if having healthcare is critical (for me it's pretty important), then you really don't have that luxury or flexibility.
There's really no reason that health insurance and employment need to go together, either. The whole notion (I believe) was started in WWII, when there were price controls. Large employers wanted a way to pay their employees more, so government offered them a loophole (surprise!): Save on taxes by making part of their compensation be health insurance. Also not surprisingly, that wrinkle in the tax law stuck around. Over time, the effect has been to crowd out the health insurance open market for individuals.
Now for a quick econ lesson: If your employer stops offering you health insurance, it won't reduce the value of your total compensation. It just means that the (say) $6000/year that goes to health insurance will go to your actual salary. Another perspective: If you're an employer, you don't really care what mix you compensate employees in, you just know that you'll allocate, say, $85,000 per year in some mix of cash, insurance, payroll taxes, 401(k) contributions etc.
Again, I'd suggest that for a lot of people who might be peers of mine, this type of scheme (and the job flexibility this allows) should be appealing to them. And overall, if you think (like I do) that promoting entrepreneurship and worker mobility is vital for the economy, this is a key part of making that happen.
Of course: Obama supporters will wish this away, and say Obama is promoting some form of universal health care coverage, making this irrelevant. Perhaps. But realistically, this isn't likely to go through, especially with our current budget difficulties. And even if you do think Obama's vision is realistic, it's still not very helpful to frame McCain's proposal as a tax increase. It's a good idea, as he's hit upon a key structural flaw in our healthcare system