Arnold Kling reaffirms his membership in the Anti-Universal Coverage Club.

Amid the current debate over expanding the State Children’s Health Insurance Program — as well as every other attempt to expand federal control over America’s health care sector — opponents accuse proponents of incrementally moving America toward a government-run system. The strategy seems to be:

First, we let government programs, the tax code, and special-interest-driven regulation slowly kill private markets. Second, we have government take over each area as it collapses: first health care for the elderly, then the poor, then the kids, then the near-elderly. Lather, rinse, and repeat until government controls it all.

Left-wing politicians pursue this strategy because they know American voters won’t swallow socialized medicine all at once. (Just look at what happened to the Clinton health plan.) And they don’t speak openly about it, because they know voters are less likely to swallow SCHIP expansion if they see where it’s headed. 

That’s why it was so refreshing to read what Ezra Klein blogged while attending the YearlyKos convention last weekend:

At the health care panel, Kathleen Stoll, from Families USA, says, “some of you may think of me as an incrementalist. I prefer to think of myself as a sneaky sequentialist.”

I think I prefer the term “sneaky sequentialism” too. “Incrementalism” doesn’t necessarily suggest an ultimate destination. “Sequentialism” suggests there is a destination, and a mind consciously devising a plan to get us there.

In an upcoming briefing paper on SCHIP, I note how that program fits the Left’s sequentialist strategy, and identify Families USA among the “Baptists” who seek to expand SCHIP because that would move us toward total government control of the health care sector.

I’ve been at a conference in Hawaii for a few days, so I don’t know if anyone called Mitt Romney to the mat for this extraordinary statement he made during the most recent GOP presidential candidates’ debate (quoth The New York Times):

But Mr. Romney took aim at Mr. Giuliani’s recent proposal to offer people $15,000 in tax deductions to help them buy health insurance. “We have to have our citizens insured, and we’re not going to do that by tax exemptions, because the people that don’t have insurance aren’t paying taxes,” he said.

I think Romney is wrong when he says, “We have to have our citizens insured.” But at least that point is debatable.

Did Romney actually say, “we’re not going to do that by tax exemptions”? Are you kidding me? Not only does Romney’s own Massachusetts health plan use tax breaks to expand health coverage — that’s all it uses. That law requires employers to offer a type of health plan (a Section 125 “cafeteria plan”) that extends the federal tax exclusion for employer-sponsored health insurance to the “employee portion” of the premiums. The whole point of the “Connector” is to extend that exclusion to health plans your employer doesn’t offer, and to make sure workers don’t lose the exclusion when they change jobs. Even the controversial requirement that all residents purchase coverage is an attempt to use a tax break to expand coverage. If you buy coverage, you get the personal exemption from the Commonwealth’s income tax. If you don’t buy coverage, no exemption for you.

And what’s this about the uninsured not paying taxes? The Census Bureau reports that 17 million of the people it counts as uninsured had household incomes over $50,000 per year. The Tax Foundation suggests that over half of the uninsured pay either income or payroll taxes, meaning that Romney is not even half-right.

(If Romney wants universal coverage, and tax breaks won’t accomplish that, how’s he gonna do it? More government spending?)

Joining the Anti-Universal Coverage Club this week is a list of organizations that have formed a new group called The Health Care Freedom Coalition. Here are a few lines from their agenda:

Most Democratic presidential candidates, one Republican presidential candidate, many business trade associations, and unions have endorsed “universal health insurance” as the solution to our nation’s health care problems.

With 46 million Americans who don’t have health insurance, these politicians and special interest groups have concluded that covering everyone will magically make health care affordable.

“Universal health insurance” is a myth. The only way to make health care “affordable” under a “universal health insurance” scheme is through price controls and limiting access. Any proposal claiming to provide “universal coverage” is nothing more than a system that must rely on private and/​or public entities to administer government-run health care. 

Emphasis added. The Health Care Freedom Coalition includes:

• 60 Plus
• Alabama Policy Institute
• American Conservative Union
• American Shareholders Association
• Americans for Prosperity and AFP Foundation
• Americans for Tax Reform
• Center for Freedom and Prosperity
• Christus Medicus Foundation
• Commonwealth Foundation for Public Policy Alternatives
• Consumers for Health Care Choices
• Council for Affordable Health Insurance
• Fairness Foundation
• FreedomWorks
• Grassroot Institute of Hawaii
• Illinois Policy Institute
• Indiana Family Institute
• Medical Savings Insurance Company
• Mississippi Center for Public Policy
• National Center for Policy Analysis
• National Taxpayers Union
• Pacific Research Institute
• Public Interest Institute
• Rio Grande Foundation
• Small Business Entrepreneurship Council
• The James Madison Institute
• Washington Policy Institute

Not joining the Anti-Universal Coverage Club this week are the U.S. Senate and House of Representatives, which approved legislation to expand government health insurance to people who don’t need government assistance, and the Galen Institute’s Grace-Marie Turner, who reiterated in her weekly newsletter:

The question isn’t whether children should or should not have health insurance. The question is how do we achieve that goal.

Robert Samuelson gets one thing wrong in his Newsweek/Washington Post column this week: Cato isn’t a conservative think tank. At least, I think it would be odd to call scholars “conservative” when they criticize the war in Iraq, the Patriot Act, the growth of executive power, the war on drugs, the holding of American citizens without habeas corpus, the federal marriage amendment, the late lamented sodomy laws, and the general attempts by both right and left to impose their moral values on all Americans through government.

But he’s right on his main point: The growth of entitlement spending, especially for the elderly, is not only a looming fiscal disaster but a fundamental shift in the nature of American government. He proposes

that some public-spirited sugar daddy (the MacArthur Foundation? Warren Buffett?) sponsor a short book. A possible title: “Facing Up to an Aging America.” Six leading think tanks would be invited to participate: three liberal — the Brookings Institution, the Center on Budget and Policy Priorities, and the Urban Institute– and three conservative: the American Enterprise Institute, the Cato Institute and the Heritage Foundation.

We accept. We’ve been writing about the entitlements crisis since 1980 or thereabouts. We’d be glad to join other research institutions in a grand public debate about how big we want government to be and what its appropriate responsibilities are.

Rudy Giuliani’s health care reform agenda is showing a little more leg.

Evidently, the Republican presidential candidate is giving some speech somewhere today. All I know is that his campaign sent me an email with bullet points about how Hizzoner wants to use free markets to reform health care. Let’s see how he does!

Reforming the tax code. Rudy seems to endorse President Bush’s standard health insurance deduction, which would reduce government’s influence and make health care markets more free. He also talks about liberalizing the rules for health savings accounts (HSAs). But as I’ve argued elsewhere, were we to adopt a standard health insurance deduction, HSAs would be undesirable. Free-marketeers would want to eliminate them.

Government spending. Unfortunately, the email also speaks of “a Health Insurance Credit to low-income Americans,” which would increase government’s influence and make health care markets less free. Rudy speaks of block grants that are supposed to do many wondrous things. But he doesn’t tell us whether he would use existing federal spending (e.g., Medicaid and SCHIP) to create those block grants or simply create new categories of federal spending. Since he also talks about “[tying] Medicaid payments to a state’s success in promoting preventative care and tracking obesity for children,” one suspects he’s not talking about block-granting Medicaid.

Medical malpractice liability. Rudy says he wants “to end frivolous lawsuits without limiting compensation for real economic loss.” That’s the trick, isn’t it? He doesn’t say how he wants to do this. But any federal approach is going to be the wrong one. The Constitution doesn’t give the feds the power to alter states’ substantive tort rules. A free-market approach would let the states sort this out in the market for such rules.

Deregulation. Rudy says he’d make health insurance more affordable by letting people purchase lower-cost policies from other states — if your state’s regulations make health insurance unaffordable. I’m sorry, did the Supreme Court tell wine lovers that they can purchase vino from other states only if it’s unaffordable in their own state? Rudy says he wants to “bring greater accountability and efficiency” to the Food and Drug Administration’s drug approval process, but he doesn’t say how.

Buzzwords. Yes, this is an entire category of health policy. Rudy believes in “creating” price and quality transparency. He wants to “invest in health IT to reduce medical errors, improve efficiency, and detect health threats” — including, quite possibly, whether your kids are a bunch of fatties. Also, “health insurance must be redefined to cover wellness as well as sickness.” (The passive voice notwithstanding, I’m fairly certain who will do the redefining.) Those goals are all well and good. But buzzword-based health care reform usually means that someone thinks they can orchestrate the health care sector better than a free market could.

Given Rudy’s free-market rhetoric, I’m underwhelmed. Still, this package puts him head and shoulders above any other presidential candidate I’ve heard from.

His plan would be dramatically improved if he dropped everything after the first bullet point (re: the standard health insurance deduction). But the other bullet points furnish enough wiggle room that I can see Rudy improving on them. Or … backsliding.

Here’s one place he could look for possible improvements.

[T]he president is recommending only $5 billion in new spending.

From David Broder’s column on the SCHIP debate.