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Who’s in Charge?

The objections to the Pelosi-Obama health-care bill are numerous. It costs too much. It is monumentally stupid to raise taxes on investors and small businesses in the midst of a recession. It will lead to rationed care. But before we get too deeply into the weeds, trying to address this or that problem and come up with an appropriate fix, it would be best to take a step back and ask a more fundamental question: Should we be doing this at all?

What we are contemplating is placing enormous power in the government to make health-care decisions. Whether through a public option that will force private insurers out of the market or some government board making “cuts” (i.e., limiting care) for Medicare and other plans, the current discussion assumes that the government in the end will make millions of decisions (hundreds of millions, really) about treatment, reimbursement, cost, and coverage. And that seems, when one thinks about it for a moment, rather scary.

John Stossel observes:

A handful of people who probably never even ran a small business actually think they can reinvent the health care system.

Politicians and bureaucrats clearly have no idea how complicated markets are. Every day people make countless tradeoffs, in all areas of life, based on subjective value judgments and personal information as they delicately balance their interests, needs and wants. Who is in a better position than they to tailor those choices to best serve their purposes? Yet the politicians believe they can plan the medical market the way you plan a birthday party.

Leave aside how much power the state would have to exercise over us to run the medical system. Suffice it say that if government attempts to control our total medical spending, sooner or later, it will have to control us.

Indeed, only people with no knowledge of the health-care system would presume to take on this much authority. Ignorance is bliss in this situation.

So what is the alternative? Create markets, enhance competition, and promote personal choice and responsibility. So long as someone else is paying the bill (e.g., the government or employers) patients have little reason to apply the same reasoning and control as when purchasing everything from iPods to car insurance. We know that in functioning markets, for both iPods and car insurance, there is price competition.

Although he doesn’t put much meat on the bones, that is what Gov. Bobby Jindal is driving at when he writes in support of a plan in which “individuals choose an integrated plan that adopts the best disease-management practices, as opposed to fragmented care” and consumers are encouraged to “be financially invested in better health decisions through health-savings accounts, lower premiums, and reduced cost sharing.” In plain English, that means giving individuals a tax credit to buy their own insurance, reduce insurance mandates and prohibitions on interstate insurance sales, and reduce extraneous costs through litigation reform. All of this means delegating power to individuals, not centralizing it in the government’s hands.

This is the heart of what is wrong with what the president and the Democrats are pushing. They want to run the show. Given their antipathy to markets and their fixation on government solutions, it is almost inconceivable that they could readjust their entire thinking to adopt the approach suggested by Jindal and other conservative reformers.

So what to do? In the words of Bill Kristol, just “kill it.” A great debate has begun and can continue up to the 2010 election. Then we can have a grand referendum on which alternative voters prefer: individual or government-run health care.


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