Unintended Consequences of a Single Payer System

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Maggie Mahar has an interesting observation in Sunday’s Washington Post:

If you’re a progressive like me, and you’re upset by the Stupak amendment, which bars federally subsidized insurance from covering abortions, consider this: What if we had a single-payer health-care system and someone like Jeb Bush or Sarah Palin were running the country?

The Stupak amendment is often described as an extension of the long-standing Hyde Amendment barring the use of federal funds to directly fund abortion. Since 1976, the Hyde Amendment has enjoyed broad support among the public, including among many pro-choice people. The sentiment seems to be summed up in the statement that “you can have an abortion as long as you don’t ask me to pay for it.”

But the Stupak amendment, part of the recently passed House health bill, the “Affordable Health Care for America” act, HR 3962 (PDF file), actually goes much farther than just banning direct funding of abortion.

HR 3962 sets up an “insurance exchange”, where private insurers would bid on individual coverage. The intent is to give individuals the same buying leverage as a large company. Sounds like a good idea, and pretty close to the “free market” solution many of us would like to see. The insurers would be standard health insurance companies like Kaiser, Aetna and Health South. Because some of the people looking for insurance would get a federal subsidy based on income levels, none of the policies issued, by private companies and paid for by individual citizen’s funds, could cover abortion services.

So if you earn $200,000 a year, and pay for every cent of your insurance policy, the federal government is stepping between you and the insurance company to prohibit coverage of abortion. Yet, many of those policies do currently cover abortion (it is, after all, cheaper than a live birth, and these are insurance companies we’re talking about).

As a pro-life Republican, I’m delighted by this amendment. But I also see the same danger as Mahar, perhaps for a different reason. I see the reach of the federal government into health care decisions as necessarily chipping away at personal freedom. Freedom to do legal things, to have an abortion, smoke a cigar, or be fat.

Mahar provides an example:

With such an administration in power, social conservatives might move to exert pressure on health-care decisions beyond abortion. For example, could women be told that their government insurance won’t cover birth control? In 2001, President George W. Bush proposed eliminating the requirement that all Federal Employees Health Benefits plans include coverage for contraception. At the time, Susan Orr, who would later become Bush’s deputy assistant secretary of health and human services for population affairs, applauded the president’s suggestion, saying: “We’re quite pleased because fertility is not a disease. It’s not a medical necessity that you have [contraception.]”

I’m glad someone on the left has seen that centralizing power necessarily means that freedom is lost, bit by little bit. Trading freedom for security is often a poor bargain, even when the security is “health care for all”.

Cross-posted to FrankHagan.com