Commentary

Health Care Debate’s Real Issue is Who Decides

At a recent campaign stop in Iowa, Democratic presidential candidate John Edwards told an audience that under his plan for national health care, preventive care would not just be paid for by the government, it would be mandatory.

Every American would be required to get annual physicals and regular tests such as mammograms and colonoscopies. Although Edwards didn’t spell out the penalties, presumably scofflaws would face fines or worse. It’s easy to make fun of Edwards’ proposal. (Can we look forward to the spectacle of couch potatoes who miss their doctor’s appointments being dragged off in handcuffs?) But we should actually be grateful that Edwards has so clearly illustrated the fundamental question that should be at the heart of any debate over health care reform:

Who decides?

That is, after all, the central question of most politics. Whether talking about educating your children, what charities you support, how you behave in your bedroom, or how you operate your business, the complexities of the political process boil down to whether you will make these decisions or whether the government will.

In health care, the question is whether you, together with your doctor, will make your most personal and important health care decisions, or whether the government will make them for you. Government-run national health care systems are all about limiting choices. For example, nearly all national health care system impose global budgets, strictly limiting how much can be spent on health care.

This leads to the rationing of care, either directly by denying certain procedures altogether, or indirectly by limiting the availability of modern medical technology. The United States has five times as many MRI units per million people and three times as many CT scanners as, say, Canada.

Today, more than 800,000 Canadians are on waiting lists for medical procedures. As Canadian Supreme Court Chief Justice Beverly McLachlin wrote in a 2005 decision striking down part of Canada’s universal care law, many Canadians waiting for treatment suffer chronic pain, and “patients die while on the waiting list.”

And if you think that the rationing wouldn’t affect you, some national systems actually make it illegal to spend your own money for care or prohibit buying private insurance. At the very least, if the United States were to adopt a national health care system, millions of Americans who are satisfied with the insurance coverage they have today could lose it and be forced into a government-designed plan that forced you to pay for benefits you didn’t want or limited your choice of doctors.

Of course, you wouldn’t have the choice not to participate. In Massachusetts, former Gov. Mitt Romney pushed through a plan that required all residents to buy a government-designed insurance plan.

Those who fail to comply have to pay huge tax penalties. And, speaking of taxes, let us remember that any national health insurance program will be financed through a huge tax increase. Edwards estimates that his plan will cost some $120 billion per year in new taxes.

Sen. Barack Obama’s proposal is slightly less expensive, but still estimated at $60 billion to 80 billion. Sen. Hillary Clinton hasn’t told us what her plan will cost, but we know it will be expensive. Yet every dollar you have to spend funding national health care is a dollar you can’t spend on your family.

National health care sounds wonderful. After all, it promises health care for everyone — for free, no less. In reality, it cannot deliver what it promises, but the politicians are still happy to make the promise anyway. All they want in return is our freedom.

We should be thankful John Edwards has shown us what’s really at stake.

Michael Tanner is director of health and welfare studies at the Cato Institute and coauthor of Healthy Competition: What’s Holding Back Health Care and How to Free It (2005).