I didn’t really plan on writing about John McCain’s “new” Obamacare alternative proposal, since it’s just a variation on every other Republican alternative dating back to McCain’s own in 2008. The basic idea is to extend the federal tax preference for employer-based health insurance policies to the individual market (some proposals, like that of George W. Bush’s, eliminate the employer subsidy), without exchanges or any other risk-pooling or collective purchasing device, and then claim all sorts of savings to pay for the new tax subsidies via the magic of competition. It includes the usual conservative pet rocks like “tort reform,” encouragement of Health Savings Accounts, and most destructive, interstate insurance sales (effectively killing state regulation of health insurers, a real irony for these states-rights-obsessed GOPers). The ACA’s “guaranteed issue” mechanism for banning exclusion of people with preexisting medical conditions would be replaced by more money for state-run “high-risk pool” ghettoes.

So far, so typical. But as Kaili Joy points out at Wonkette, there’s a big irony that isn’t noticed so often when Republicans talk about trusting doctors and consumers as opposed to bureaucrats in determining the best care:

We shall scratch our heads and ponder while we rejoice that McCain apparently would like to cover abortions in his fantasy McCainCare. Seriously! Okay, not seriously, but sort of seriously, if you look at it from a certain point of view.

“Finally, it establishes doctor-led quality measures ensuring that patients receive quality care defined by people that know medicine, not by government.”

We will resist the temptation to be grammar scolds to move right along to the larger point that McCain thinks it would be a fine idea for patients and the doctors, NOT the gubmint, to make medicine-type decisions. We agree! We also think that is probably not what McCain actually meant because we know when Republicans blah blah blah about keeping the government out of your health care decisions, they are not talking about lady decisions, because ladies are dumb and need the government to make their decisions for them, duh.

Since McCain’s proposal is apparently identical to the House bill introduced earlier in the year by Rep. Tom Price, it is very clear it would ban use of its subsidies for any insurance including contraception or “abortion,” recognizing that the conservative definition of the latter term generally includes, against every expert medical opinion, “abortifacients” like Plan B or the IUD.

So even as tax subsidies for health insurance are somehow good unless they are means-tested and operate through purchasing exchanges, you can trust the docs except when you don’t.

Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.