Monday, May 18, 2009

The Government Option

It's hard to believe but we came very close to universal health care around 20 years ago during the administration of George H. W. Bush. The program proposed was called "Pay or Play". An employer "played" by providing insurance. Those who did not play would pay - they would be charged a fee which would go to a government-run health program. This would not provide coverage but it would mean that everyone who had a job had insurance coverage. The plan had wide support in Congress and the backing of the White House. It was supposed to be the best of both worlds. It would preserve private health care and insurance and it would eliminate the competitive advantage of not covering health care.

Then it fell apart. The reason why is instructive today.

At some point during the negotiation between Congress and the White House, someone pointed out to President Bush that it would be easier for companies to "pay" than for them to "play". As time passed, most employers would switch coverage to the government run plan and eventually the would be the norm. That was more than Bush had bargained for. He had no intention of dismantling the insurance industry and nationalizing health care but that was the inevitable result of Pay or Play. The White House backed away from the proposal. Members of Congress who always favored Canada's single-payer plan disowned Pay or Play and the endeavor collapsed.

I'm mentioning this because one of the big issues in the new health care debate is the existence of a government-run alternative. Some on the Left such as Paul Krugman, insist that no plan should be passed that does not include a government-run portion.

In all likelihood, any insurance plan offered by the government would have some sort of subsidies in it that would make it more attractive than the for-profit alternatives. That puts us right back to the government slowly nationalizing health care.

There some very solid reasons why you don't want the government in charge of your health. The biggest one is that insurance companies don't have the authority the the government has. Right now the government has no financial stake in your health and it is still intrusive. Once your health care depends on the public coffers then the government has the right to micro-manage your life.

This is happening in England and Scotland where councilors are knocking at doors to give obesity advice.

Part of being free is being able to choose your lifestyle. If you want to be a couch potato you can be. Put the government in charge of your health and we will see mandatory daily calisthenics like in 1984 or Communist China.

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