An article in the Boston Globe yesterday finds that Republican nominee John McCain is stuck between a rock and a hard place -- and no, we don't mean "Iraq and a hard place." The issue is health care, and according to the Globe, the Arizona senator's aides are "scrambling to come up with ways to satisfy those who want more coverage without violating what they call McCain's conservative principles on the issue."

McCain knows that most Americans are desperate for meaningful health care reform, which is why he insists that "we can and must provide access to health care for all our citizens -- whether temporarily or chronically uninsured, whether living in rural areas with limited services, or whether residing in inner cities where access to physicians is often limited." What stands in his way is his antipathy toward government intervention in the "free" market (though there's some flexibility on this: see his support for the Bear Stearns bailout). McCain supports measures that encourage individuals to buy insurance at the expense of employer group coverage. He would, for example, replace the employer tax deduction for health insurance with a tax credit for individuals or families, and he would allow individuals or small businesses to buy insurance from states with less regulation. Unlike either Obama or Clinton, McCain has not formulated a detailed plan, but he has outlined his agenda here.

The problem is that while eviscerating group coverage might -- just might -- make insurance less expensive for the young and healthy, it will certainly make it more costly, for older, sicker people. As the Globe noted, when a reporter asked the senator if his own experience with skin cancer would lead him to require insurance companies provide coverage to people with preexisting conditions, "McCain flatly rejected the idea. 'That would be mandating what the free enterprise system does,' McCain said." But of course, free enterprise is not going to solve the problem of access -- if it could, there wouldn't be a problem in the first place. At this rate, universal coverage is for McCain merely a platitude, and an insincere one at that.

But the Globe reports that the Republican is working on it. For patients with preexisting conditions, McCain supports what he calls "a special provision including additional trust funds for Medicaid payments" -- which "has left even some of his aides unsure of his meaning." It might mean diverting Medicaid funds into a special program for high-risk pools, but nobody is certain yet. Or he might back an additional tax credit for high-risk patience to subsidize their insurance, funded by unspecified savings in Medicaid. "We'll put out more details," an adviser told the Globe. "As we do, it will be clearer to people."

They have their work cut out for them.