Health Care Socialism, Fascism, or Freedom?

The so-called “public plan option” — the part of Obamacare that would create a new government healthcare insurance entity at enormous cost and under bureaucratic control —  has been unmasked as a means to a single-payer end.  The plan’s supporters have said so, from public plan option architect Jacob Hacker to President Barack Obama himself.  (It’s all over YouTube.)  

Most Americans, of course, do not support a single-payer system, which used to be called socialized medicine before the word “socialism” was deemed beyond the bounds of mainstream political discourse.  Its euphemistic reincarnation, the “public plan option,” may also fail as its intended purpose is more widely understood.
Then what?  Will politicians scrap the whole idea of a centrally-planned, government-imposed health insurance system, or will they simply alter their plans to co-opt private insurance companies by assuring them of their continued existence and profitability?  Unfortunately, all indications are that they’ll opt for the latter.

In 1974, the great Nobel laureate economist Milton Friedman said:

“The two chief enemies of the free society or free enterprise are intellectuals on the one hand and businessmen on the other, for opposite reasons. Every intellectual believes in freedom for himself, but he’s opposed to freedom for others.…He thinks…there ought to be a central planning board that will establish social priorities.…The businessmen are just the opposite — every businessman is in favor of freedom for everybody else, but when it comes to himself that’s a different question. He’s always the special case. He ought to get special privileges from the government, a tariff, this, that, and the other thing.”

Sounds like 2009.  The alliance of paternalistic intellectuals that want to force Americans to do what’s good for them and big business interests that want guaranteed profits comes together in what I believe will be the centerpiece of “bipartisan” health care reform: the individual mandate.

The major new government controls that Democrats insist upon would prohibit insurance companies from excluding pre-existing conditions and from risk-adjusting their premiums.  On their own, those regulations would destroy all but the largest insurance companies with the deepest risk pools, and would send premiums skyrocketing, as we’ve seen in states that adopted these measures.  

So the insurance companies will insist on, and probably receive, an individual health insurance mandate that will make it illegal not to buy their products.  The penalty for violating the mandate will be a sizable new tax, or garnishing your wages.  This, also, is already in the Obamacare bill.  (Actually, it’s already the law in Massachusetts, thanks to the “Romneycare” law, and an utter failure)

President Obama beat Hillary Clinton in part by opposing such a mandate, but now he supports it.

Under this plan, the government would actually require by law that every American purchase a particular product from a small group of favored companies.  Not surprisingly, a lobbyist for a major health insurance company recently told me this is precisely the outcome his employer wants.  This explains why — contrary to popular belief — the major industry players are not funding any of the groups broadly opposed to big-government health care plans.

If single-payer (directly or indirectly via the public option) is socialism, then the individual mandate is corporatism.  An individual mandate is every bit as much a threat to patients as an explicitly government-run plan.  Under an individual mandate, politicians and bureaucrats would get to define what counts as health insurance, deciding based on political considerations what must be covered and what can’t be covered, reimbursement policies, and potentially every aspect of your health care.  Insurance companies, with their guaranteed profits and new taxpayer-funded subsidies, would be happy to oblige.

Fortunately, there is a third alternative: freedom.  We could end the ridiculous tax policy that says if your employer buys your health insurance it’s tax free, but if you buy it yourself it’s taxed.  It shouldn’t be taxed in either event.  

We could deal a blow to costly state insurance regulations and mandates by allowing competition across state lines.  We could put meaningful curbs on jackpot justice, in which trial lawyers and some lucky plaintiffs make millions while the rest of us face ever higher health care costs as a result.    We could give Medicare and Medicaid recipients control over the taxpayer dollars they receive, so they have more choices and an incentive to spend wisely.  

Advocates of freedom cannot be satisfied beating the public option; we must stop the individual mandate and start from scratch with real reforms that put patients first.