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What? This is about policy? 

Let's put aside for the moment our prevailing political conversation about gender, race, pigs, pit bulls, lipstick and vice presidentially imposed change, whatever in the world that could possibly be.

How about a quick detour to a matter of actual public policy?

Health care weighed heavily on our minds until gasoline prices shot up and mortgages got foreclosed on. It still ought to weigh heavily on account of its perhaps being our greatest human and financial challenge of the next few decades.

Republicans, conservatives and many in the independent center of American politics embrace the noble-sounding notion that we ought to be individually responsible for our health insurance. They preach that we must avoid group-based solutions, which they decry as collectivism, even socialism.

They make it sound so all-American, so virtuous, this mantra of every person responsible for himself in a free market. Actually, though, individualism is an arcane and impractical notion in America.

We don't apply it to schools. Excepting the occasional home-schooling parent, most of those fleeing public education turn to private schools in which people go together to pay steep tuition and use the combined proceeds for the group schooling of many children at once. It's called a class.

We don't dare think that each of us is individually responsible for paving his own road from home to work and church. We don't for a moment insist that, instead of a collective coordinated defense strategy, each of us should be responsible individually for disposing of any terrorists we might confront in our own back yards.

Yet on health care we decry a coordinated collective solution. Even more odd is that conservatives and Republicans seem to object not merely to government coordination, but even to the very foundation of American health insurance. That would be the group coverage provided through the collective efforts and dollars of workers and their responsible employers.

The employer contribution in your behalf to your group health plan — if you're lucky enough to have one — gets doled out before income taxes apply. Bush unsuccessfully tried, and now McCain proposes again, to change that to make your employer's health insurance contribution straight income to you.

McCain would thereby raise your payroll deduction for income taxes. Your company's payroll costs also would increase in your behalf, since your employer would have to pay on a higher level of taxable income for your Social Security.

In exchange, McCain wants to give everybody a tax credit at the end of the year for their costs of securing health insurance.

This way, he says, individual responsibility and the free market system can work their magic. This is the best way, he says, to get everybody covered as efficiently as possible. He argues that this would lead to competitive pricing, innovative products and smart shopping. He lauds this swell-sounding “freedom of choice.”

Bu he's effectively proposing to make it altogether less attractive for your employer to work with you and your workplace colleagues in all of your collective interests for group health insurance. He's proposing to weaken the one working aspect of American health insurance, even if, like everything else, it's imperfect.

By the way, McCain has no plan — other than to “work with the states” — on how to deal with those who would be hard to insure individually because of pre-existing conditions.

Barack Obama, by contrast, specifically states that his plan preserves and attempts to “build on” the employer-based system. He wants to entice all who are uninsured into groups by which they also could enjoy collective advantages. He presumes to mandate that no one could be rejected or discriminated against by price or type of insurance for having a pre-existing illness.

It's change either way. It's real substance and a real difference. And it's actually important to any American who might be thinking about someday getting sick.

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