When government picks up the tab for health costs, it inevitably feels it is responsible for curtailing them through "prevention," which can often elide into compulsion. As Faith Fitzgerald, a professor at the UC Davis School of Medicine, put it in the New England Journal of Medicine: "Both healthcare providers and the commonweal now have a vested interest in certain forms of behavior, previously considered a person's private business, if the behavior impairs a person's 'health.' Certain failures of self-care have become, in a sense, crimes against society, because society has to pay for their consequences."
But there's another factor at work as well. We are seeing a return to the idea -- first championed by social planners in the progressive era -- that government can and should play the role of parent. For instance, Michael Gerson, once a speechwriter for President Bush, advocates a new "heroic conservatism" -- an updating of his former boss' compassionate conservatism -- that would unleash a new era of statist regulations. On the stump, Hillary Clinton refers to her book, "It Takes a Village," in which she argued that we all must surrender ourselves to the near-constant prodding, monitoring, cajoling and scolding of the "helping professions." Clinton argues that children are born in "crisis" and government must respond with all the tools in its arsenal from the word go. She advocates putting television sets in all public gathering places so citizens can be treated to an endless loop of good parenting tutorials.
So, because the government 'pays the bills' they have the right to tell you how to live our lives? Of course the money they're using to pay those bills come from the very people they're trying to control. The only problem is that the people within government making those decisions are no wiser than the people they want to control. They're no less screwed up. But somehow they believe they are better qualified to tell us how to live our lives. What arrogance!
But wait! There's more!
We've seen this before. The original progressives -- activist intellectuals, social reformers, social gospel ministers and other would-be planners in the late 19th and early 20th centuries -- touted "social control" as the watchword of their movement. One reason the progressives supported World War I so passionately was not because they supported the aims of the conflict but because they loved domestic mobilization. John Dewey, the American philosopher and educator who sang the praises of the "social benefits of war," was giddy that the conflict might force Americans "to give up much of our economic freedom. ... We shall have to lay by our good-natured individualism and march in step." The progressives believed that people needed to be saved from themselves. Journalist and commentator Walter Lippmann dubbed average citizens "mentally children and barbarians." "Organized social control" via a "socialized economy" was the only means to create meaningful freedom, argued Lippman, Dewey and others. And by free, the progressives meant free to live the "right" way.
A similar dynamic defined much of Nazi Germany. Nazi Youth manuals proclaimed that "nutrition is not a private matter!" "Gemeinnutz geht vor Eigennutz" -- essentially, all for one, one for all -- was the rallying slogan of the Nazi crackdown on smoking, the first serious anti-tobacco campaign of the 20th century. The first systematized mass murder in Nazi Germany wasn't of the Jews but of the "useless bread-gobblers" and other lebensunwertes leben ("life unworthy of life"). The argument was that the mentally ill, the aged, the infirm were too much of a drain on the socialist economy.
Could we end up following the same path? Oh, it wouldn't happen all at once. It would be a little here (No Smoking!!), a little there (No Transfats!!), and then one day some bureaucrat would make the decision that you no longer contribute enough to society or the economy that supports it. You've become a drain and therefore should be euthanized. After all, the government pays all the bills.
Am I overstating the case? Maybe. But are you willing to take the chance?
Would a national health care system lead to this outcome? Probably not. But it would lead to poor health care for everyone...except the bureaucrats and those who have the wherewithal to afford health care outside the system. That doesn't seem fair, does it? So let's tell the government, and Those-Who-Would-Be-President, to back off.