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Give John McCain credit, as usual, for bringing some originality and boldness--verging on recklessness--to the debate about the country's future. The health care plan he announced this week is not just more of the same, a continuation of the Bush administration's feeble tinkering, as critics are saying. It bravely takes the principles weakly advocated by the White House on this subject and actually tries to put them into practice. McCain, moreover, is half right about what should be done to fix the system. Unfortunately, half right is not good enough. Voters are unlikely to go for his plan, nor should they.

McCain, the GOP's presumptive presidential nominee, throws himself behind the principle of "consumer-driven health care." The key, in this view, is to make the private market in health insurance more competitive. At present, most Americans are covered through employer-based plans. This arrangement is underwritten, so to speak, by the tax break that employers get for their health insurance costs. Workers have limited choices among insurance providers, and little reason or opportunity to press suppliers for lower prices. Employers try to lower insurance costs, but they don't make direct choices about services.

If you look around, ordinary markets work pretty well. One should hesitate before rejecting that model out of hand. Even in the best of worlds, it is true, making health care work like an ordinary market is difficult, but the current system does not even try. The employer-provided model's big weakness is that it lacks the crucial component: consumers with choices. As a result, it gets the worst of both worlds: incomplete coverage (thrown onto the individual insurance market, many "bad-risk" workers not covered by their employers are unable to find affordable plans) and increased costs (because the key market discipline is weak).

"There are those who are convinced that the solution is to move closer to a nationalized health care system," McCain said in announcing his plan. "They urge universal coverage, with all the tax increases, new mandates, and government regulation that come along with that idea. But in the end this will accomplish one thing only. We will replace the inefficiency, irrationality, and uncontrolled costs of the current system with the inefficiency, irrationality, and uncontrolled costs of a government monopoly."

McCain's approach is to encourage people to buy their own insurance rather than get coverage through their employers. He proposes a refundable health insurance tax credit of $2,500 a year for individuals and $5,000 for families. The government would pay this credit directly to health insurers for workers who don't have coverage now or who opt out of their employer-based plans. The idea is akin to a health care voucher. "Millions of Americans would be making their own health care choices again," McCain said. "Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs. It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower costs."

In one respect, McCain follows the example of Hillary Rodham Clinton and draws a political lesson from the fate of "Hillarycare." He assures people who are content with their employer-based arrangements that nothing would change. He is proposing, he says, not to dismantle the current system but to give people a new option that, if enough took it up, would start a transition to an individually based insurance model.

Before turning to what is wrong with McCain's idea, at least give him credit for seeing that the employer-based approach is central to the problem. The plans proposed by Democrats Clinton and Barack Obama both affirm the employer's role while also broadening coverage. Employer-based insurance not only neuters the forces that would otherwise press down on costs, it also locks workers into jobs that they otherwise might not want and multiplies the sense of insecurity that so many Americans complain of lately. If you lose your job, your health insurance is at risk as well. Thrown on your own resources under the current system, you might not be able to find affordable insurance, so a medical emergency may often mean financial ruin. McCain's voucher-like approach tries to address this--partially, at any rate.

And that is the problem. His proposal would widen access to health insurance and make insurance much more portable from job to job, but it would fall way short of providing universal coverage. Even with his proposed tax credit, many millions of bad-risk individuals--including those with pre-existing conditions--would find it impossible to afford coverage. Younger and healthier workers would have an incentive to opt out of employer plans in favor of cheaper alternatives, a step that would raise premiums for those left behind.

Clinton and Obama would place obligations on insurance companies to cover high-risk people and provide new publicly supported alternatives to private coverage. McCain says that he "will work tirelessly to address the problem" but comes up very short on specifics. He offers more detail on what he will not do than on what he will. "I won't create another entitlement program that Washington will let get out of control. Nor will I saddle states with another unfunded mandate."

McCain says he aims to build on the experience of states in finding ways to cover the uninsurable. He cites North Carolina's agreement with Blue Cross and Blue Shield to act as an insurer of last resort, and points out that 30 or so states have some form of high-risk health insurance pool. He talks of developing a "guaranteed access plan" that would reflect the best experience of these initiatives--and that he would implement, he says, with the "collaboration and consent" of the states.

All of this is much too vague. It inspires no confidence that the gaps in coverage that concern so many Americans--those who worry that they might lose their coverage in the future as well as those who, for one reason or another, lack it today--will be filled. With the cost and availability of health care ranking at the top of many voters' anxieties, it is past time for action. McCain's best efforts (subject, as he says, to the states' cooperation and consent) to work this all out will rightly strike many voters as too little, too late.

Admittedly, some of the attractions of the Democrats' plans are more apparent than real. Neither candidate, despite Clinton's protests to the contrary, is offering truly universal coverage. Clinton's individual mandate would cover everyone only if the penalties for noncompliance were severe, but she is not advocating that. Obama's plan explicitly acknowledges that gaps in coverage would remain. McCain is wrong to imply that the Democrats' plans diminish choice or represent any kind of socialized medicine--Clinton and Obama have taken great care to avoid that charge. But he is right that one of the fundamental issues in health care is cost control. The Democrats are not yet confronting this question seriously.

A plan that sought universal or near-universal coverage, while weaning people away from the employer-based approach, could in principle be far superior to the ideas now on the table.

So McCain is vaguest on assuring wider coverage, and the Democrats are vaguest on how to get the expense of the system under control. Each, however, proposes to leave the basic fee-for-service model, which perversely rewards providers for supplying treatments rather than good health outcomes, essentially unchanged. Fixing that is difficult--but vital if costs are ever to be curbed.

The three White House contenders are offering the electorate a choice between flawed alternatives--but it is a choice, nonetheless. The Democrats put the emphasis on access, McCain on portability and affordability. The Democrats entrench the role of employer-provided insurance; McCain seeks to undermine it.

What a shame that no candidate is offering a plan combining the virtues of the two approaches. A plan that sought universal or near-universal coverage (supported by mandates plus subsidies, or by refundable tax credits or an explicit voucher scheme), while weaning people away from the employer-based approach, could in principle be far superior to the ideas now on the table. This would be true precisely because such a plan would combine Democratic egalitarianism and the Republican preoccupation with choice and competition. Neither side wants you to know it, but these can be complementary not contradictory themes. Any such plan, though, would be an even bigger change from business as usual. It would be more radical, and look it.

In the realm of the feasible, I would guess that the Democrats have the better of the political argument. McCain's old-fashioned "government monopoly" attack on their plans is no good: The new proposals have been designed to deflect it. Beyond that, what concerns swing voters, I think, is not the numbers of people currently uninsured, or even the cost of insurance--because, as McCain points out, workers in employer-based schemes need not concern themselves with cost (even though in the end it comes out of their pay). What concerns them most is the insecurity of their own arrangements.

These workers are covered now, but what happens if that should change--and if a medical problem emerges in the meantime to become a pre-existing condition? The assurance of adequate coverage is the big thing, and the Democrats are much more persuasive on that than McCain.