Vice President Gore and Sen. Bradley have begun their competition to
promise the country that under a Gore or Bradley administration the
federal government would take the next steps toward the elimination of
disease. They call this utopian project “health care reform,” but it is
actually just an attempt to sneak the country another step or two down
the road to socialized medicine without waking us up to the fact. This
is to be expected from Democratic presidential contenders, of course.
But as George W. Bush begins to look for Sister Souljah moments in which
to deal daring, courageous and, of course, compassionate smacks to the
moral conservative wing of the Republican Party, we can expect to hear
proportionately diluted Republican versions of a similar socialist
promise from him. It is a good time, therefore, to review the principles
that ought to govern an American, and therefore a Republican, approach
to government health policy.
We should not countenance the notion, whatever form it takes, that it
is the business of the government to provide health care for all the
American people. In the Clinton era of stealth socialism, the favored
camel’s nose is some version of the proposal to provide comprehensive
government health care for the “children.” This is a classic stalking
horse argument that Clinton and others use to disguise the ultimate goal
of health socialism. They will start with children and go to old people.
There is no natural limit to the solicitude of government if we do not
refute the root principles of the proposed “reforms” at the beginning.
The great majority of American children do not exist in juvenile
packs a la “Peter Pan” or “The Lord of the Flies”; they live in
families. The presumption that the provision of health care for
America’s children is a task that government must undertake is an
implicit indictment of the families in which American children live.
When we presume that government must act to provide health care for the
children, we reveal that we don’t think parents are able to meet this
most obvious responsibility.
Now, it is clear why liberals would want to establish the incapacity
of parents to provide health care for their children — the entire
liberal agenda is based on establishing that American citizens are not
capable of responsibility, and are thus not to be trusted with the power
of self-government. The agenda of health socialism is thus part of the
overall liberal strategy of establishing the moral incompetence of the
American people. Here, as in every major policy issue we face, it turns
out that the “G.W. Shuffle” away from moral concerns plays into the
hands of the liberals, especially of smart ones like Sen. Bradley. By
avoiding the truly crucial moral questions such as abortion, Bush
signals quite clearly that he thinks he cannot speak to the citizenry in
terms that truly challenge their moral sense. But if Republicans are not
willing to treat citizens as moral adults, liberals will happily
continue to propose policies that presume childish citizens and the need
to increase government control over American families.
Why are liberals able to make a plausible case that many parents do
not provide adequate health care for their children? One reason is that
the government has been taking out of parental hands the resources they
need in order to meet their responsibilities. One of the most effective
ways to help the children of America receive adequate health care would
be to abolish the income tax and give back to the people of this country
control of one hundred cents of every dollar they earn. Then they will
be able to make decisions that give priority to the health care of their
family and children. Under the income tax system, government first
creates poverty by taking money away from families with excessive
taxation. This, of course, makes it more difficult to afford health
insurance. Government then stands ready to help us accomplish what we
would have been able to do for ourselves if we had just been left alone.
As a transitional measure, Republicans should fight for the
establishment of tax-free savings accounts for medical expenses. But we
won’t need special medical savings accounts when every savings account
in America is safe from the taxman. We won’t have to depend on the
government’s willingness to permit savings for medical purposes to be
tax free once we have established the universal fact that all our income
and savings are tax free and are to be taxed only when we make the
decision to perform an open transaction in the retail marketplace.
Our guiding principle must be to move toward policies that presume
and empower the capacity of our citizens to build their own lives and
fulfill their own responsibilities. This principle can guide us even in
our reform of those government programs that we will have to live with
for some time — such as Medicare and Medicaid. These programs,
committing a mistake that private health insurance is moving to
eliminate through HMO reform, have adopted approaches that isolate the
consumer from the choice of what medical services to purchase and how to
To see how little sense this makes, imagine that we bought cars the
way the government distributes health care. Our government-supplied
“personal transportation insurance” would be ready in case we needed to
buy a car. We would go to the car dealer, who would examine our
situation the way a doctor examines our body. And the car dealer would
conclude that we need a certain kind of car, but without either of us
having to worry about the price. We would just send the bill to the
office of personal transportation insurance, and they would pay it.
What would happen to the price of cars if we bought them that way?
When dealers no longer had to worry about giving better value and
greater efficiency than their competition, we would get higher priced
cars at lower efficiency, and eventually there would be people who, by
that very system supposed to help them, would be priced out of the
market and have no car. That’s what we have done with health insurance.
Even in the realm of government-provided services, we need to put the
power back in the hands of the consumer. Recipients of government
medical aid should have a voucher account established for them which
they could spend down or preserve, with the assurance that, up to a
certain level, if they didn’t spend the money in any given year, it
would roll over and be available to them in future years. Over time we
could restore, even within government programs, the incentive on the
part of the consumer to pay attention to the relationship between price
and value. It is only when we have empowered consumers to be the
policemen of that price/value relationship that we will see a proper
efficiency restored to the health care system.
By restoring that efficiency — which is to say, by ending
government-generated inefficiency — we would make health care in its
basic essentials more like refrigerators or cars than a rare luxury. In
America, anyone but the poorest of the poor can afford refrigeration and
basic transportation if they order their lives with responsibility and
diligence. Yet in spite of all the so-called provision being made by the
government, people are now being priced out of the health care system.
We won’t fix this problem except by reintroducing the principle of
consumer responsibility in private health care — which the market is
already bringing about — supported by a structure for government
programs that empowers the consumer to make responsible choices that
will effectively take account of the costing as well as the satisfaction
that they get from their health care services.
But neither these specific policies, nor the elimination of the
income tax that will make the general empowerment of consumers a
practical reality, will be accomplished if our politicians continue to
avoid the underlying argument about the fitness of our people to lead
responsible lives. Health care, like other economic questions — and
indeed all-important issues in human life — ultimately reduces to the
moral facts. A nation of children will not provide adequately for
itself. The liberal plan is to cause a national plague of
irresponsibility and the shirking of duty, in the hope that we will
conclude sheepishly that we must hand over control of our lives to the
government, and become wards of the state instead of a free people.
Nothing restores moral self-confidence more effectively, on the other
hand, than turning to face a difficult issue that we have been guiltily
avoiding. The moral questions that G. W. Bush and his handlers have said
they will ignore — above all the issue of abortion — will eat away at
our national moral self-confidence until resolved. Until we resolve
them, real practical solutions to important but subordinate policy
questions such as health care will remain elusive, and we will find
ourselves sliding instead toward an external chaos to mirror the