What's Really at Stake in the Health Care Debate

Shamelessly, Obama has since floated the idea of taxing health care benefits -- the very notion that he falsely accused McCain of advancing. Only, Obama isn't talking about shifting the tax break from employers to individuals, as McCain proposed to do. He would merely add a tax on employers, exactly what he falsely accused McCain of wanting to do.

So whereas McCain would have given a health care tax break to individuals and families, thereby injecting greatly needed life into the health insurance market, Obama would do neither. Under McCain's proposal -- which again, sadly, he didn't defend -- private insurance would have become far more affordable for those who buy their own insurance and, even more importantly, would have become far more affordable for the uninsured -- the very group that needs the most help. Under Obama's proposal, government's coffers would be strengthened without reducing the call to add still more government-run health care to meet the continuing needs of the uninsured. Thus, Obama's proposal would go a perfect two-for-two on his own peculiar scorecard.

Take another example. The only part of Medicare without an abysmal budgetary track record is its prescription drug program. Seniors choose their own plans, as private companies compete for their business. Satisfaction rates are high, political manipulation of prices is low, and, by nearly any measure, the program has been a great success. But it's a market-based program. So how did the New Yorker recently depict it, without a trace of irony? As being comparable to Chairman Mao's Great Leap Forward. Both are portrayed as exemplifying the horrors of a "master-planned transformation." (One couldn't make this up.)

In the 15 years since the defeat of Hillary-care, the battle over health care policy has been waged as if only one side understands what's at stake. If those who believe in limited government don't want to see power centralized and consolidated in Washington to a far greater extent even than today, they had better figure out how to talk about health care -- and now.

They need to showcase government-run health care's decades-long track record of extraordinary, skyrocketing costs. They need to compellingly outline an alternate vision that calls for the federal government to take active steps to promote a more vibrant free market, the crux of needed reform. And they need to advance a sensible, federalism-based approach that lets government help come to the rescue of the uninsured before Obama lays down the tracks for nationalized medicine and redesigns the entire system to let government come to the "rescue" of us all -- insured and uninsured alike.

Contrary to what our president told us on Inauguration Day, the question we should ask is not merely whether government works -- although we know that "outside of its legitimate function, government does nothing as well or as economically as the private sector" -- but whether it is too big or too small, whether it will be limited or unlimited, whether we will control it or it will control us.