A Public Option Today, Outlawing Twinkies Tomorrow

Much of the current debate over healthcare reform has centered on the Democrats’ proposal for a public option that would insure people who cannot, or who choose not to get private insurance.  But this debate has largely ignored the fact that the federal government already pays for the healthcare of millions of people through Medicare, Medicaid, Veterans’ Affairs hospitals, and emergency rooms that are legally required to treat anyone in need of urgent medical care, regardless of nationality, immigration status, or ability to pay.

In short, there is already a de facto public option.  And state and local governments often pick up the tab when the federal government does not.  But when someone else is paying, there are usually strings attached.  Public finance of healthcare gives the government hugely expanded license to regulate our private lives, which the government has already demonstrated a propensity to use.

In 1998, the states sued the tobacco companies, eventually reaching a $246 billion settlement.  The rationale for that lawsuit and for related state and federal taxes on cigarettes is the cost of smoking to Medicare, Medicaid and the VA.  A frequent justification for banning trans fats or requiring people to wear seat belts is that even when people engage in private activities that endanger only themselves, the government has to cover a large part of the cost.

In short, government-funded healthcare turns private issues – like wearing a seat belt or overeating – into public issues by requiring the public to pay for the consequences.  Should publicly funded healthcare expand with the proposed $1.6 trillion public option, government control of our private lives is likely to expand with it. If you dislike the idea of covering healthcosts for people who drink and smoke too much or don’t wear a motorcycle helmet, you are not alone. With taxpayers paying for a larger share of the nation’s healthcare, you can count on millions of other rational Americans to vote for politicians who ban, tax, or restrict behaviors that have the potential to increase costs.

Under this system we foresee massive encroachments on our personal liberties through higher taxes on all sorts of goods: from sweets, to alcohol, to meat and dairy products.  We also expect a series of outright bans like the trans-fat prohibition that exists in many cities.  There may even be, heaven forbid, a couch potato tax.  When Twinkies are outlawed, only outlaws will eat Twinkies.

And who knows where the encroachments into our private lives will end?  In Japan, where most people receive government health insurance, a national law requires every person between 40 and 74 to have their waistline measured.  Those who exceed the limit (33.5 inches for men, 35.4 inches for women) face financial penalties and mandatory dieting “re-education.”  The Japanese Ministry of Health justified this intrusion into people’s private lives by explaining – you guessed it – that they were trying to reduce the government’s rising healthcare costs.

Big Brother’s interference in private affairs won’t be limited to those who are uninsured.  The restrictions that are already in place because of government involvement in healthcare finance certainly aren’t.  Even if you have your own private health insurance, you still must pay cigarette taxes and wear a seat belt.

If our concerns seem far-fetched consider the fact that about a dozen states now have taxes on soda.  The politicians who vote for these taxes justify them by referencing the need to reduce the expense of treating obese people.  If the government can do that, why couldn’t and why wouldn’t it tell you what you can eat for dinner and how much television you can watch?  What about driving convertibles, drinking alcohol, skydiving, or not wearing a scarf when it’s cold outside? The nanny state doesn’t just take care of you, it assumes that you can’t take care of yourself.

If the government expands the amount that it spends on healthcare, and our fears about restrictions on private life-style choices do not come true, the alternative is almost as bad. People will bear even less responsibility for the health-related consequences of their actions.  If they eat too much, drive too fast, and sleep around, the government will subsidize their risky behavior with other taxpayers’ money.  As a result, our nation’s health will suffer.

We already have a wasteful, expensive system that encourages free riding and subsidizes frequently unhealthy and occasionally reckless lifestyle choices.  It’s no small wonder that so many people in America are both uninsured and unhealthy.  The government is inadvertently encouraging it.  As taxpayers pay for more and more, the problem will get only worse.

The expansion of public healthcare by an estimated $1.6 trillion will give voters in America a tough choice: Pay for your neighbor’s unhealthy lifestyle or have your right to live as you see fit circumscribed.  Neither of those options is appealing to us.

We are not arguing that healthcare does not need to be reformed in this country.  The system is obviously broken.  We are also not arguing against charity.  We feel compassion for those who are sick and in pain, and we want to expand healthcare availability in a responsible and productive way.  However, we are nervous about government charity.  It often comes along with rules that limit individual liberty.  When it doesn’t, it removes some of the incentives for healthy living.

People who believe that the government doesn’t have the right to tell you how to live your private life used to be called liberals.  Anybody who still considers him or herself a liberal should think carefully about the long-term consequences of the government option in the current healthcare reform proposal.

Brandon Kirsch contributed to this piece.