Charles Wheelan, Ph.D. The Naked Economist

If I were John McCain's campaign advisor, I'd offer him one seemingly counterintuitive piece of advice right now: Start talking more seriously about health care. The Democrats have carved out this issue as their own. The Republicans haven't made it a priority, and that's a mistake

Both the Republican Party and arguably the country would be better off if McCain rolled up his sleeves and put together a credible health care overhaul. Here are the reasons that McCain and other Republicans should not only care about health care reform, but make it a regular talking point on the campaign trail:

• Because the current system is shockingly inefficient.

Let's blend economics and science fiction for a moment and imagine that a conservative businessperson arrives on Earth from another planet. If we asked this person to assess the U.S. health care system using the standard business metrics, what would he say?

It's a mess -- by almost every reasonable indicator. We spend much more than other industrialized countries and have no better outcomes. We invest too little in preventive care and too much on high-tech, end-of-life procedures. Our record-keeping is poor. Administrative costs are high. We gather strikingly little data on which procedures are cost-effective and which aren't. We have no mechanism for ensuring that doctors and hospitals conform to best practices. And so on.

Any sane, pragmatic person with basic business sense -- the kind of person who makes up the economic heart of the Republican Party -- should look at this system and recognize that it's an inefficient use of a big chunk of America's resources. And that's before we even get to the problem of the uninsured.

• Because the health care system harms the competitiveness of American firms.

Republicans are keenly aware that taxes and regulations imposed by the U.S. government can put American firms at a disadvantage in the global market. That makes sense. So why are the Republicans so seemingly unaware of (or uninterested in) the fact that the United States is the only major industrialized country that saddles its corporations with primary responsibility for worker health care?

General Motors has to worry about health care; Toyota (outside the United States) does not. With our health care costs growing much faster than inflation, how is that not a serious business problem?

• Because the health care system is a drag on innovation.

Suppose you work for Microsoft or Intel, and you're ready to strike out on your own with a great high-tech business idea. Now let's further suppose that one of your kids has serious asthma, or some other preexisting condition. Know where you're going to be working next year? Microsoft or Intel. The cost of buying an individual family policy on your own -- assuming you can even get the whole family covered -- is too prohibitive.

Economists have identified the concept of "job lock," which is basically a fancy term for what I just described. Workers forego the opportunity to start new business ventures because they fear leaving the relative security of a large group health insurance plan, particularly if they or a family member has a preexisting health condition. If Republicans are going to obsess (rightfully) over capital gains taxes and other policies that encourage or discourage risk and innovation, then health care ought to be on that list.

• Because a health care blip is the one thing that can financially devastate even upper-class families.

The Republican base doesn't consist of millions of people who are currently uninsured. I get that. But it would be a huge mistake to assume that health care is only an issue for people who are just barely getting by. In fact, the one thing that could send an otherwise wealthy family completely off the rails is getting hit with a major medical problem during an unlucky stretch without insurance.

It couldn't happen to you? Imagine that your daughter has just finished graduate school but hasn't found a job yet. She's young, healthy, and talented, and it'll only be a few months before she's employed and covered. Except that she's been having some strange symptoms, and three weeks later she's diagnosed with leukemia.

She can't afford the treatment she needs; you can, if you're lucky. Bye-bye, retirement savings.

• Because one of the most promising health care reforms was implemented by a Republican governor.

That would be Mitt Romney. I'm still puzzled about why his failed presidential campaign was built around dressing himself up as a social conservative rather than highlighting his true comparative advantage as a smart and pragmatic businessman.

In the latter role, Romney signed an innovative health care reform bill as governor of Massachusetts that dramatically expanded coverage through subsidies and mandatory insurance. The plan isn't perfect, but it's a pretty good starting point for what an overhaul for the whole country should look like.

No doubt Romney would have talked much more about his health care success if he'd made it to the general election. I think he should've started talking about it during the primaries.

• Because the Republicans have an empathy deficit.

The genius of Ronald Reagan was that he could connect with working-class Americans. He won massive support from blue-collar workers who ordinarily would've voted Democrat. The Republicans have lost that touch, and need it back if they hope to win Reagan-like victories.

Recapturing the Main Street connection will take more than the standard Republican talking points on tax cuts, terrorism, and the non-economic issues of the religious right. The typical small-business owner worries more on a daily basis about health care costs than terrorist attacks. Ronald Reagan would've found a way to talk compellingly about both.

• Because the Republicans have more chance of getting a sensible reform passed.

The Democrats may "own" the health care issue at present, but they've got a big problem when it comes to getting anything passed: There's a nearly irreconcilable rift within the party between those on the far left who would like a Canadian-style single-payer system, and the moderates who would prefer to patch up what we've already got.

The Republicans don't have that problem, as there's no support for pulling a Canada. A sensible Republican proposal would pick up votes from centrist Democrats and create the potential for a truly bipartisan reform. The bill Mitt Romney signed in Massachusetts was passed by a Democrat-controlled legislature.

We're privileged to have an impressive group of presidential candidates. The one who wins is going to be the candidate who convinces Americans that he or she "gets it" -- that he or she understands what would make our lives easier, better, and more secure. Ronald Reagan did that. Bill Clinton did it, too.

I don't think any candidate, Republican or Democrat, can do it in 2008 without being serious about major health care reform.