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The Road to Health-Care Serfdom


I sensed a bit of frustration during President Obama’s state of the union address when he said, “The longer it [the health-care overhaul] was debated, the more skeptical people became.” I’m not totally sure what point he thought he was making. After all, it wouldn’t speak well for a proposal if prolonged discussion of its particulars created doubt about its value. But surely he didn’t want to convey that message.

Perhaps he and his speechwriters overlooked that subtle message and had another complaint in mind: Any idea, bad or good, can be talked to death by Congress.

Recall that Obama did not want a lot of talking about his health-care proposal. He wanted a bill fulfilling his ambition to redesign 17 percent of the U.S. economy on his desk before the August congressional recess. On its face that schedule was ridiculous, not to mention dangerous. Congress is never more threatening than when it rushes. Of course that deadline was missed, as were the Thanksgiving, Christmas, and New Year’s deadlines. He badly wanted this gold star in his first year. He didn’t get it.

Now, with the loss of the Democrats’ 60th vote in the Senate, the once-awesome health-care juggernaut has ground to a virtual halt. Obama’s rush suggests that he didn’t expect Sen. Edward Kennedy to be available for long to cast his pro-overhaul vote and that he feared that if things went on too long, a Republican could win Kennedy’s seat — which is exactly what happened.

Obama’s venting of his frustration brings to mind F.A. Hayek’s classic, The Road to Serfdom. That book, published in 1944, argued that if a democratic society seriously pursued central planning of the economy, despotism would inevitably emerge. Hayek’s argument is simple and powerful: Everyone could favor government planning in principle, but that does not mean that everyone favors the same plan in every detail. Yet there can be only one plan. Legislatures, being the “talk shops” they are, are not likely to dissolve all the differences and arrive at a single plan, certainly not in a timely manner. In such circumstances, it would be tempting to turn to a “strong leader” to seize control of the process and impose a plan.

Thus, in the real world of politics the choice is between government planning and freedom.

The controversy over health care is a microcosm of Hayek’s thesis. Obama wants Congress to devise a plan for health insurance and, by implication, health-care delivery. A majority in both houses favors having a plan but not the same plan. So the debate has gone on for close to a year. Fortunately, the American people seem skeptical of government planning and would not tolerate Obama’s assuming the role of “strong man.” So the danger Hayek warned of is small. It also means that comprehensive planning of health insurance and health care is unlikely.

Obama urged his party to keep pushing “reform” despite all that has happened. But in an election year, especially with the Massachusetts omen, it also seems unlikely they will do that.

But that does not mean the threat of further government intervention in health care has passed. While many people have a healthy aversion to a big comprehensive plan, they may be less concerned over what looks like lots of small adjustments — even if they add up to a big comprehensive plan. Leading Republicans, who like to pretend they are for freedom and strict limits on government power, have long been on record as favoring many individual components of the 2,000-page bills pushed by the Democrats. For example, Republicans favor mandating insurance companies to cover preexisting conditions — which is welfare, not insurance. They also favor taxpayer subsidies for health insurance and defended Medicare and Medicaid, which together make up close to half the health-care spending in the United States.

The upshot is that what Obama could not get in one big bill, he may well get in a lot of small ones — with Republican votes. Instead of being freed, the health-care market will be deeper in the government swamp.

Outright central planning is not the only road to serfdom.

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    Sheldon Richman is former vice president and editor at The Future of Freedom Foundation and editor of FFF's monthly journal, Future of Freedom. For 15 years he was editor of The Freeman, published by the Foundation for Economic Education in Irvington, New York. He is the author of FFF's award-winning book Separating School & State: How to Liberate America's Families; Your Money or Your Life: Why We Must Abolish the Income Tax; and Tethered Citizens: Time to Repeal the Welfare State. Calling for the abolition, not the reform, of public schooling. Separating School & State has become a landmark book in both libertarian and educational circles. In his column in the Financial Times, Michael Prowse wrote: "I recommend a subversive tract, Separating School & State by Sheldon Richman of the Cato Institute, a Washington think tank... . I also think that Mr. Richman is right to fear that state education undermines personal responsibility..." Sheldon's articles on economic policy, education, civil liberties, American history, foreign policy, and the Middle East have appeared in the Washington Post, Wall Street Journal, American Scholar, Chicago Tribune, USA Today, Washington Times, The American Conservative, Insight, Cato Policy Report, Journal of Economic Development, The Freeman, The World & I, Reason, Washington Report on Middle East Affairs, Middle East Policy, Liberty magazine, and other publications. He is a contributor to the The Concise Encyclopedia of Economics. A former newspaper reporter and senior editor at the Cato Institute and the Institute for Humane Studies, Sheldon is a graduate of Temple University in Philadelphia. He blogs at Free Association. Send him e-mail.