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.

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.