HARLESTON, S.C. - Senator John McCain yesterday unveiled a health-care plan that provides increased prescription drug payments and puts new money into Medicare and veterans' benefits, while relying mostly on tax breaks to expand coverage to the 44 million uninsured Americans.
McCain's speech was filled with broad statements about how it was unacceptable to have so many uninsured people, but his language was vague in many areas and he left out some detailed cost estimates.
Asked after his speech to say how many of the uninsured would be covered under his various proposals, he responded: ''Off the top of my head, half of them.'' A McCain spokesman said the total cost of the senator's program would be $4.3 billion in the first year, rising to $7.6 billion by the fifth year.
The setting of the speech said much about the direction of the campaign. McCain has staked his campaign on winning both the New Hampshire primary and the South Carolina contest 18 days later. He joked at a press conference yesterday that his strategy book is highly complex: ''Every page says `South Carolina.'''
His senior aides said this week that McCain would probably drop out if he loses in South Carolina, which is considered friendly territory for the former Vietnam prisoner of war because it has the nation's highest per-capita number of veterans.
In his speech before more than 500 members of the Charleston Rotary Club at the Charleston convention complex, McCain invoked his favorite theme about the evil of special interest contributions.
''Let's be realistic,'' McCain said. ''The reform we need is not possible as long as special interests control Washington. As long as the special interest agendas are greased with unlimited amounts of soft-money contributions to our campaigns.''
The Arizona senator said that he would try to expand coverage to the uninsured by increasing the availability of health insurance to small business and by expanding the use of the Medical Savings Account, an IRA-like program that provides a tax break for funds used to pay medical bills.
McCain did not say how much this expanded tax break would cost, nor did he explain how much he would expand the current $500 per year tax break available under the Medical Savings Account program. After his speech, he said he would increase it to $1,000. Asked whether that would be enough to cover annual medical expenses for many people, McCain said he would consider raising it further if necessary.
Lorie Slass, a spokeswoman for the non-partisan group Families USA, which seeks affordable access to health care, said that McCain's omission of a specific plan to provide coverage to all Americans ''is a big hole in his proposal.''
McCain's plan relies heavily on the current HMO system, which he noted has been criticized for putting cost-containment before providing some necessary health benefits. McCain said he can solve that problem by allowing independent boards to mediate disputes, and to allow patients to sue HMOs over a denial of benefits.
''HMOs were designed to bring new efficiencies to our health care system, but for millions of Americans, the cure has become part of the disease,'' McCain said. ''Cost containment has become a goal in and of itself, rather the means toward better, more affordable health services.''
The GOP front-runner, Texas Governor George W. Bush, has not yet announced his health-care plan, while another leading Republican candidate, Steve Forbes, has proposed a plan that, like McCain's, expands the use of Medical Savings Accounts.
Bush spokesman Scott McClellan, reacting to McCain's proposal, said Bush's plan for Medicare reform ''offers more competition'' and said McCain's proposal for patient protection echoes a plan Bush has already instituted in Texas and supports nationally.
The McCain plan relies far less on government funds than the proposals put forward by the two Democratic candidates. Vice President Al Gore has proposed a plan that would cover all children and gradually lead to universal coverage, while former Senator Bill Bradley has proposed a sweeping measure that includes coverage for 95 percent of Americans.
Under McCain's plan:
Seventy percent of the budget surplus would be dedicated to shoring up Social Security and Medicare.
Senior citizens who are struggling financially would be eligible for expanded drug coverage. A ''regional pilot project'' would extend catastrophic drug coverage to senior citizens regardless of income, but McCain did not specify how many people would be covered under such a program. He said later that the $6 billion program would be run on a trial basis in five states.
McCain said that many of the nation's 11 million uninsured children could get coverage under existing programs, provided families take advantage of the tax breaks that he has proposed. Then, in a statement that characterized much of his speech yesterday, McCain added: ''If the package of reform I've outlined isn't enough to do the job, we'll do more.''
An additional $2 billion would be allocated to fund what McCain called a shortfall in veterans' health-care benefits.
