The Magazine

Standing Up for Liberty

The health care debate is about insurance; it should be about access.

Dec 21, 2009, Vol. 15, No. 14 • By JIM PREVOR
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The triumph of Reaganism, as represented by the passage of the Kemp-Roth tax cuts in 1981, was a declaration of intellectual independence by conservatives and Republicans who decided to no longer be "tax collectors for the welfare state."
Equally, the current battle to defeat plans for a national health insurance program will be a richer victory if conservatives and Republicans not only defeat the proposed legislation, but articulate a vision that rejects the fearful, risk-averse attitude intrinsic to the bills passed by the House and proposed in the Senate.

Key to the case for Obamacare have been two notions: that getting everyone covered by insurance is some kind of "moral imperative" and that a lack of health insurance is some unique problem in which government must overrule family decisions about how best to allocate funds. Both should be rejected by conservatives and Republicans.

The issue that has moral weight is access to health care, not access to insurance. Many people elect not to buy collision insurance for their cars because they are financially capable of absorbing the loss. If Bill Gates wants to go without health insurance and would rather pay as he goes, would virtue be served by forcing him to buy insurance?

Many wealthy people buy a high-deductible policy--a policy that would not qualify as insurance under the bills in both the House and Senate--and pay for the less-expensive services as they need them. They tend to buy such policies for their children, whose incomes may not be high at all. Yet all these people have adequate resources to procure needed health care. The fact that the national debate has focused on insurance for health care--as opposed to the accessibility of care--is a byproduct of the particular worldview that all "basic needs" should be provided by communal institutions, preferably the government but, alternatively, highly regulated companies that do the government's bidding.

If the Republicans want to address the real issue of access to care, there are numerous ways to do it:

-- They could build more medical schools and wreak havoc on the American Medical Association's efforts to restrain the supply of doctors. The slow growth in medical school capacity has forced many perfectly qualified Americans to go to medical school in foreign countries or give up their dream of becoming a doctor all together.

-- No more "certificates of need." Legislation could be passed to prevent states and localities from restricting the ability of hospitals to compete by requiring preapproval for offering certain programs, building certain facilities, and acquiring certain equipment.

-- The government could fund a large ROTC-type program whereby bright students who want to become doctors can go to medical school for free, in exchange for a few years of service in free clinics.

All of this would make care more available (and so lower costs), and none of them has anything to do with insurance.

The push to insure everyone is, moreover, a decision to endorse a risk-averse society. There is little question that if every uninsured family in America were offered a cashier's check in the amount it will cost to provide that family with health insurance--checks that could easily be in excess of $15,000 each year--and simultaneously offered the chance to sign the checks over to purchase health insurance, many, many families would elect to take their chances and do something else with the money. A real question, not addressed in the current debate, is why the Democrats want to avoid giving autonomy to families, who best know their own situation--and why Republicans are not standing athwart the effort to deny families such freedom and yelling, "Stop!"

Perhaps these families would use the money to start a small business, send a child to college, go to night school, or save a child from a horrible inner-city public school system. Is there any basis for thinking that paying for health insurance is morally superior to helping a family in any of these ways?

The Democrats have framed the health care debate as one between their efforts to help the uninsured and Republican concerns about budget deficits. One wonders if Republicans wouldn't do better to focus on freedom and individual liberty. By proposing to give families money or vouchers that they could use to buy health insurance or any other thing they deemed helpful to their family's future, Republicans could appropriately frame the health care debate. Let the Democrats be the party of the dictatorial nanny-state, demanding insurance over opportunity. Let the Republicans be, well, pro-freedom.