In times of crisis, Americans are sometimes more inclined to trust in government solutions to their problems than in private or self-reliant solutions. Most politicians are more than willing to empower themselves. But as most citizens understand, what government gives it can also take away. And when the crisis subsides, government almost never retreats fully to its role before the problem occurred.

When government creates a new program or adds to its responsibilities, it is important to remember that its actions — being the result of the endless tug-of-war that defines the nature of special interest competition in an era of BIG government — often tend to breed unintended, negative consequences. In the case of health care, which many people say shows some "crisis" signs, the worst-case scenario would be a British or Canadian-style single-payer system in which politics dominates and dictates who gets what care and at what public cost. A former cabinet secretary under the first President Bush put it well when he said a national health care system run from Washington would combine "the efficiency of the post office with the compassion of the IRS."

Indeed, when government is in charge, even routine matters can become hot political potatoes. A February 2000 Mackinac Center commentary pointed out that this precise phenomenon was in evidence recently when hospital food became an election issue in Canada.

Nonetheless, some people still favor a government-run health care system. These people contend that this approach would be a positive step toward eliminating America’s burgeoning number of uninsured that currently stands at over 40 million. Examples of this can be found in recent and past public policy proposals and ballot initiatives throughout the nation. Ballot Measure 23 was placed before Oregon voters on November 6th of 2002; it would have created a state-run universal health care program, but was defeated as nearly 80 percent of those going to the polls decided they didn’t want politicians and bureaucrats in charge of things like life support machines when they can’t seem to get classroom education right.

In spite of the failure of Hillary Clinton’s 1993 proposal for nationalized health care, the idea just doesn’t go away. Al Gore recently called for it. Speaking to the Harvard School of Public Health on November 21, 2002, United States Senator Edward M. Kennedy said, "I intend to introduce a proposal for universal coverage for all Americans in the new Congress." What makes such talk seem all the more absurd is that we already have a government-run health care system that is itself an unmitigated disaster. It’s the Veteran’s Hospital program and a 1994 Cato Institute study of it showed that the great majority of those eligible for free or low-cost care in it shun it like the plague. Why is it that such profound failure is so totally ignored by people like Gore and Kennedy? Are they really interested in helping people, or just growing government?

Incidentally, in case you still think after reading the Cato study that there’s nothing wrong with VA hospitals that Gore and Kennedy can’t fix with a little more federal compassion and somebody else’s money, take a look at this story from the Kansas City Star : www.kansascity.com/mld/kansascitystar/news/opinion/2939672.htm.

Universal, government-provided health care appears to some to offer a possible solution to the double-digit health care cost increases that businesses and individuals have recently faced, though one is hard-put to think of anything government has ever taken over that subsequently became cheaper.

Indeed, governments have done much to boost health care costs and thereby price some people out of the market for both insurance and care. For example, states have passed more than 1,500 mandated benefit laws. Attempting to comply with such laws, in addition to the plethora of other state laws and regulations adopted to regulate the insurance industry, is an arduous, costly task. The National Center for Policy Analysis (www.ncpa.org) has shown that at least 20 percent of uninsured Americans are uninsured because the cost of complying with state mandated health benefits from acupuncture to hair transplants has priced them out of the marketplace. John Sheils of the Lewin Group, a national health and human services consulting firm, estimates that every 1 percent increase in health care premiums causes 300,000 people to drop their insurance coverage nationwide.

Tort and malpractice liability problems plague health care and, as President Bush so eloquently stated in a January 16, 2003 speech in Scranton, Pennsylvania, are a huge reason for runaway health care costs. The tort system is an essential government function, yet as it applies at least to health care, it’s broken and politicians like Gore and Kennedy are dead-set against fixing it. Before government takes over health, is it too much to ask of these guys that they get the government to make even a modest attempt at cleaning up its own act?

Meantime, the promising option of Medical Savings Accounts (MSAs) is vastly underutilized. It represents a key ingredient in curtailing health care costs because it would help solve the "third-party" payment problem and would also allow Americans to fix their health care system without the heavy hand of Washington. Organizations like the Cato Institute, the Heritage Foundation, and the National Center for Policy Analysis have championed MSAs for years and have produced a wealth of supporting documentation, all available for even Washington politicians to see on these organization’s Web sites (www.cato.org; www.heritage.org; www.ncpa.org). Over the past decade, the Mackinac Center for Public Policy has also produced some insightful pieces, accessible on this site via these links:

http://www.mackinac.org/168

http://www.mackinac.org/154

http://www.mackinac.org/180

(If you’re interested in knowing more about how the "universal," single-payer, problem-plagued Canadian health care system really works, see the Web sites of three leading Canadian research organizations: the Frontier Centre for Public Policy in Manitoba, www.fcpp.org, the Fraser Institute in British Columbia, www.fraserinstitute.ca and the Atlantic Institute for Market Studies in Nova Scotia, www.aims.ca).

While the 107th Congress adjourned with no action on MSAs beyond passing a one-year extension of a very limited project, prospects for action on MSAs in the 108th Congress may be good. President Bush has announced that permanent enactment of MSAs occupies a major role in his legislative agenda. With a Republican controlled House and Senate willing to follow his direction, President Bush should be able to capitalize on his leadership role and accomplish the goal of obtaining permanent enactment of the statute creating MSAs.

In any event, the evidence is monumentally huge with regard to government in health care. It leaves so much to be desired that private alternatives like Medical Savings Accounts surely deserve far more consideration than they are currently getting.

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(Kevin C. Waycaster is a Compliance Analyst at American Republic Insurance Company in Des Moines, Iowa and can be reached at 515-558-6582 or kevin_waycaster@aric.com. Lawrence W. Reed is president of the Mackinac Center for Public Policy in Midland, Michigan).