So let’s get right to the point:  I predict Sen. Obama will lose the Presidential election.  Secondly, HSAs will continue to be the fastest growing type of health insurance and the fastest growing type of bank account and the fastest growing type of investment account.

Senator McCain’s win will cause shock and awe world-wide, and in the councils of the Democratic Party, but it will bring political balance to a precarious economic and political time in the United States.

McCain’s win will also cause a serious, bi-partisan approach to health care reform.   But before we get to that, let’s set the playing field: The fight over health care reform can be broken down, in general, into two camps:  the Democrats want to give control over your health care to a government run entity, for example, like Medicare.  The Republicans want to give you control of your health care by giving you cash to help you buy the care you want or you need.

Republicans say the Democratic plans will cause rationing and a loss of control by the individual, just like the HMOs tried to do, which caused a public back lash.  Americans, unlike Europeans, hate being told what to do by a corporate or government bureaucrat.

Democrats say the Republican plan will not give enough money to families.  (McCain wants every family to get $5,000 to purchase health insurance).  To the Democrats, the Republican plan is like lowering a ten foot rope into a fifteen foot hole.

So, how will this health care debate, post-McCain victory, turn out?  Don’t hold your breath, even if my prediction is wrong, and Obama wins, there are serious economic and political structural problems with any legislative attempts at health care reform.

Structural Problems with Achieving Health Care Reform

When voters are confused about the details or merits of competing plans, voters as a block generally default to the dominant cultural characteristics of America.  The most recent instruction on American’s cultural and political views on health care rationing and corporate or bureaucratic control to access to care Americans want, is the example of what happened to HMOs.  HMOs tried to ration and control.  They are in full retreat.  The HMOs and their philosphy were, as von Clauswitz would say, defeated “in detail” by the average American. This is why, when Democratic staffers on the Hill open up, they make reference to an Americanized version of government health care.

Furthermore, Americans do not like to innovate with their health care.  This tendency translates into a collective decision to simply not to change anything.

The Republicans are, in general, not inclined to conduct a massive health care reform because of the lack of political benefit they received from the Medicare Prescription Drug reform, and the Democrats have had two massive attempts at health care reform fail, the first being the Clinton Health Plan, and the second being the Patient Bill of Rights. It is also instructive to look at the California experience, where the Republicans and Democrats joined hands, labored mightily for state-wide health care reform, and in the end, no bill even emerged from Committee.  Not to put too fine a point on it, but health care reform’s political history is littered with failures and serious political consequences for those who have failed.  The Democratic party lost control of the U.S. House after the Clinton plan failed.

Then there is the most serious problem, the one that tied the shoe laces of reformers in California, cash.

This year, the combined spending on Medicaid (for the low income), Medicare (for the seniors) and the tax break for employer provided health insurance is close to, if not above, the one trillion dollar a year mark  — and the baby-boomers have not even begun to seriously hit the rolls of Medicare.

By 2017, Medicare will be adding 11 million seniors.  In nine years (in 2017) there will be 55 million seniors in Medicare.

The thing about reality is that it is hard to avoid.  Eventually, even the most ardent attempts at convincing the public that the King has a beautiful flowing gown fail, and eventually reality catches up with the wide-eyed desires of “change.” California wanted change.  They just could not afford the sort of change they wanted.  Reality hit hard.  The bill did not make it out of Committee.  The bi-partisan alliance failed.  The result is their will be no change in California in health care at the state level for some time.

Ninety some odd Democrats in the U.S. House of Representatives want Medicare for All.  Notwithstanding the fact that the Republicans would rub their hands with glee at the prospect of the Democrats attempting to pass that legislation, the Democrats are going to have to try and meet the effective veto these House members will have on the Democratic House Leadership’s reform proposals.

It is very easy to see the House Democrats over-reaching politically, and going for what they really want the next time health care reform is readied for legislative action.  This is going to create serious tensions within the Democratic party between those who want something that will pass, and those who want to be pure.  Ninety members is a big number.  If even a third of them banded together to force their caucus to accept their version of health care reform, the Democrats would be tied up in knots for a very long time.  Why would the Medicare for All crowd want to delay any action?  By waiting, more and more Americans (i.e. baby boomers) will be in Medicare — government run health care.  Why not wait until those numbers grow substantially to push for Medicare for All?  Time makes their constituency grow.

Then, of course, there is the fact that $1 trillion of government spending attracts $1 trillion worth of special interests.  By the time every interest that could derail or materially alter any deal is satisfied, the end result may be worse than the current state of affairs.

Other than the:

1. inherent American cultural problems faced by any government control of health care
2. lack of most American’s desire to take risks or innovate with their health care
3. gun-shyness of both political parties when it comes to health care reform
4. $1 trillion worth of influence and power of the special interests arrayed around the $1 trillion in U.S. government health care spending
5. past legislative failures of Clinton’s plan, the Patient Bill of Rights and the California experience — and the political fallout for failure
6. tensions within the Democratic party between the 90 Medicare for All U.S. House cosponsors, and those Democrats who would rather do something else, and
7. the massive growth in the current health care spending by the U.S. government on Medicare, Medicaid and the employer provided tax break — leaving little new money to work with for any reform plan

health care reform’s future is, well, um, uncertain.  Each one of these seven points represent a high degree of difficulty for any reforms to overcome and be passed into law.  Taken together, there is an extremely high level of difficulty.  Add into the seven points above that changing the tax code is the most difficult of all types of legislative action to achieve, and the level of difficulty of health care reform just became the most difficult type of legislation to pass of any kind in the United States.

This is why the “believe in change” slogan rings hollow for many Americans — it is just like wishing the King did have clothes.

The latest Gallup poll, in the aftermath of the glowing media coverage of Senator Obama’s European World Tour, has McCain up 4 points among likely voters — that is, McCain has a 4 point lead among voters who are most likely to actually go to the polls and vote.

This represents a 10 point swing in McCain’s favor.  Gallup had him down 6 points among likely voters a month ago.  Women over 40 are responsible for three or four points of this lead.  They are breaking to McCain over Obama by electorally significant margins.

In a time of economic, political and military uncertainty and tumult, Americans will, I predict, go with the safer choice of experience — Senator John McCain.