Freedom Can't Be Rationed

By Rep. Mike Pence from the June 2009 issue

"If you think health care is expensive now, wait until you see what it costs when it’s free!"

As Congress prepares to consider health reform, P. J. O’Rourke’s famous quip provides an important context to the debate. President Obama and Democrats in Congress have proposed a government-run health care plan that would “compete” against private health coverage. Estimates have suggested that such “competition” would encourage employers to reduce costs by eliminating their health benefits for employees. As a result, as many as 119 million Americans will lose their coverage, forcing most of them into the government-run plan. In his budget, the president proposed nearly $1 trillion in new spending as a mere “down payment” to fund this “free” health care gimmick.

The truth is, government-run health insurance takes away citizens’ freedom, forcing them to accept a government decree about intensely personal health decisions. At a time when Medicare faces unfunded obligations of nearly $86 trillion, dumping more than half of all Americans with private coverage into a government program will dramatically jeopardize our fiscal future. To make matters worse, it will take away citizens’ freedom to choose their doctors—and the freedom to choose, with their doctors, the treatment option that best meets their health needs.

Democrats have admitted both their desire for government to control health carew and the effect of such control on ordinary Americans. A provision in the recent “stimulus” bill will spend $1.1 billion for comparative effectiveness research. While few would dispute the wisdom of scientific research comparing the medical benefits of various treatment options for a given ailment, Democrats have shown a strong desire to use such research to examine the cost-effectiveness of medical treatments—as a precursor to government rationing of care. In fact, a draft committee report produced by the Democratic majority noted that “more expensive [treatments] will no longer be prescribed” as a result of rationing sparked by effectiveness research.

Peter Orszag, President Obama’s new budget director, was candid about the impact of government control on health care when he cited studies in a 2007 report noting that “patients who might benefit from more expensive treatments might be made worse off” if the government rations access to costly—but potentially life saving—care. In other words, the true cost of “free” government-run health insurance will be a loss of freedom for millions of Americans who will be forced to give up their freedom to choose medical treatments that will actually work for them.

Here’s how one Michigan mother expressed her exasperation with the government-run Medicaid program: “You feel so helpless thinking, something’s wrong with this child and I can’t even get her into a doctor….When we had real insurance, we would call and come in at the drop of a hat.” This mother’s helplessness in a vast government bureaucracy is the antithesis of freedom—lack of freedom to choose one’s doctor resulting in a lack of access to care.

Our nation needs health reforms that expand Americans’ freedom. Removing the current inequities in the tax code that force individuals whose employers don’t offer health coverage to use after-tax dollars to buy insurance—and pay 30 to 50 percent more as a result—would put coverage within reach for millions of Americans. Allowing individuals to purchase health insurance across state lines would increase consumer choice while expanding insurance coverage for as many as 12 million individuals. Just as important, these options would ensure that doctors and patients, not government bureaucrats, make important health care decisions.

While Democrats argue that a government-run plan is more “efficient,” I strongly believe that the nationalized plan would look a lot like Medicaid does today—cheap, broken, and government-rationed coverage that most Americans do not want. The American people want to keep their health care freedom—and Republicans need to respond to their call.