AHA Roundtable

A Bleak Day for Defenders of Personal Liberty

David T. Beito, July 2012

This is a bleak day for defenders of personal liberty. The Supreme Court has abrogated its responsibility as a co-equal branch. If the federal government can force us to buy insurance, under the catch-all pretext of calling it a “tax,” it can force us to do almost anything. The same post-New Deal court which often upholds choice on abortion, pornography, and contraceptives continues to let politicians trample on the personal choice of Americans over their own pocketbooks. In we cannot freely spend the fruits of our labor on such a deeply intimate decision as health care, any other liberties are ultimately meaningless.

While the impact of this ruling is important, Obamacare was not a sharp historical break but rather the culmination of a long trend toward more state intervention in health care. When Obama took office, the federal government already paid more than 40 percent of the costs in perhaps our most politicized industry. His Republican predecessor presided over the greatest leap forward in governmental control since the 1960s by implementing Medicare Part D. Ever greater state intervention by both parties has only brought Americans higher premiums and less personal freedom.

Ironically, the only alternative the GOP can present voters in November is Mitt Romney, the father of the mandate and a continuing defender of Medicare Part D. Romney’s pioneering statist record and flip-flops will make him easy prey in any debate. A President Romney may push halfheartedly to repeal the mandate, though that is likely to be stopped by a Democratic filibuster, but he shows no desire for fundamental market reform.

Any meaningful present or future challenge to the corporatist/statist status quo will probably have to come from a third-party candidate. Such a candidate can make a politically appealing case on a platform which supports personal medical savings accounts, allows health insurance companies to compete across state lines (as life and casualty companies can now freely do), permits purchase of low-cost high-deductible policies, eases patent laws and import restrictions which push up drug prices, and enables non-MDs, including nurse practitioners and midwives, to provide services now monopolized by doctors. Another necessary plank of such a platform would be repeal of tax differential favoring third-party insurance, thus giving an incentive to secure coverage through genuine health care cooperatives which do not depend on employment.

While even Obama recognizes, at least in theory, that cuts in government health care subsidies will be necessary to prevent long-term financial crisis, neither party will be able to do so as a practical matter because of their mutual fealty to the military-industrial complex. A true future champion of reform may find that the most politically feasible way to wean Americans off the health care status quo is to cushion any suffering caused by the transition by first cutting our trillion dollar foreign empire and bringing home the troops.

—David T. Beito is professor of history at the University of Alabama.