“Workin’ hard or hardly workin’?”

We all know people who say things like that, yet we’re too polite to point out that it stopped being funny decades ago. That tact only means we’ll hear it again, and you know how grating that can be. It’s the same feeling I get when I read health-care proposals that will magically cure the problem with market forces. “Let people take control of their health care and watch competition lower prices.”

Insurance companies certainly aren’t quivering at the thought of consumers driving down costs. They know they stand to make more money in this “ownership society,” which is why they heavily contribute to the party that touts it.

U.S. Sen. John McCain, R-Ariz., is the latest politician to roll out this free-market cliché. Under his presidential vision, people would be given tax credits to go buy their own insurance. The credits don’t come close to covering a typical premium, which is about $12,000 a year. As evidenced by the cherry-picking that goes on now, the true competition would be for low-risk customers. The already sick or those with high risk factors would be rejected. McCain himself would probably be denied coverage because of his history of melanoma.

So then what? Well, McCain says he would work super hard with states to form high risk insurance pools. But states, including Washington, already have those and the premiums are so high that only about one in six eligible people participate. So what about the rest? They’d go without, just like now.

Workin’ hard or hardly workin’?

The truly needy? A centerpiece of the McCain plan is health savings accounts. These are plans with high deductibles in exchange for lower premiums. They are often packaged as investment vehicles that allow participants to sock away thousands of dollars tax free.

The problem for most people is embodied in an old Steve Martin joke about how to become a millionaire: “First, get a million dollars.”

The plans only work for people who have several thousand dollars to set aside, so it’s unsurprising to see that the average household income for those who had HSAs in 2005 was $139,000, according to a recent government study.