What's Really at Stake in the Health Care Debate

Times are tough for most Americans, but it's a boom time for government-run health care. Between the $86 billion worth of "economic stimulus" going to Medicaid, the fresh $32 billion for the State Children's Health Insurance Program (SCHIP), and the proposed $634 billion "down payment" on a massive expansion of federal health care, the Obama administration and the Democratic Congress are determined to make 2009 a year of prosperity and abundance for at least one element of American society.

While this timing may seem strange -- giving out raises with taxpayer money, while taxpayers brace for layoffs -- it is not surprising. The health care debate is not just about health care anymore. It's a surrogate debate over the centralization of power in Washington.

Take SCHIP. Ostensibly a program to cover poor children, it will now cover nearly half of all American kids. This begs the question: do you want to be among the half of all Americans whose kids receive public assistance health coverage or among the half who gets to pay for it?

In addition to being an end in itself, health care has become a means to the end of repudiating the vision of the American Founders and of most Americans. The Founders believed foremost in liberty and they set up a government to protect it by decentralizing and separating powers. Today's "progressive" movement rejects that vision and calls for the centralization and consolidation of power, with the aim of providing for people by orchestrating the coercive authority of the administrative state.

Thus, the issue of health care will determine a great deal about our fate as a nation. Through it, we will embrace our founding principles of limited government and liberty or we will embrace an alternate vision that seeks to triumph over these.

If conservatives doubt that this much is truly at stake here, they should learn from liberals, who suffer from no similar lack of conviction. A tip-off is how over-zealously and irrationally supporters of government-run health care attack any efforts to reform health care along free market lines.

A centerpiece of John McCain's health care plan involved shifting the health care tax break from employers to individuals. The employer health care tax break, a relic of World War II-era wage restrictions, has long impeded the development of a vibrant free market for health care. It keeps consumers from buying directly from insurers or caregivers, thereby reducing consumer choice and price transparency and reducing insurers' incentives to develop innovative, affordable plans to meet consumers' needs. It's also unfair, as it taxes some people's health care expenses but not others'.

Obama could reasonably have criticized McCain's proposal for slightly reducing tax revenue (the projected result) or, amusingly, for being "too much of a change." Instead, Obama bizarrely attacked McCain's plan as an attempt to "tax your health care benefits for the first time ever," and McCain didn't understand his own plan well enough to rebut the charge. This demagoguing was the least honorable tactic that Obama openly employed in the entire campaign, as he willfully misrepresented McCain's plan. Why did he do it? To get elected, of course -- but also because the Left understands what's at stake here. A vibrant free market for health care is the primary threat to those whose central goal is to expand government's role.