Ultimately, the biggest problem with nationalizing health care (let's not kid ourselves, that's what these bills do, and that's the objective) is that it pits Americans against one another. In passage of the Stupak Amendment, the pro-choice lobby has just learned a bitter lesson (well, actually, they received a lesson, but I don't think they learned it), which is that they may not get to control the benefit packages. This will be true everywhere, though. Under nationalized care, you want my grandmother to die (or at least we can say that you will benefit if my grandmother dies, and one's desires tend to follow incentives), because your costs go up if she's kept alive with expensive care. That other guy wants your baby to die (or be aborted - will Catholic Bishops learn the true lesson of their triumph this week when they have to decide on the final bill?) rather than live with birth abnormalities that require expensive health care. The reality of human nature, noted by Adam Smith more than 200 years ago, is that we take a prick on our own finger much more seriously than the deaths of thousands halfway across the world. Thus, the reality of government health care is that people will want theirs from the common pot, and they will vote to get it, whatever it does to their neighbors.
With private insurance plans, there is still a cost shifting dynamic - that is the purpose of insurance - but your health benefits are not subject to the votes of others. This is why we have found, per Adam Smith, that freedom makes things better. We ration shelter in this country, even though shelter is even more important to life than health care - but we do it through the market. We ration food, but we do it through the market. We ration clothing, but we do it through the market. Why? Because markets, backed by some social welfare safety net, do it better, not just because they are generally more efficient, but because they are ultimately less arbitrary and more fair, less divisive, and leave much more room for charity, family, church and community than a system managed by the cold, bureaucratic hand of the state. Markets always leave an escape route, they have the flexibility to adjust, and they mean that one person's rights are not subject to the whim (vote) of another.
Once we have nationalized health care, we will battle over payments for abortion every year. We will battle over grandma's care every year (whether you want to call them "death panels" or something else). We will battle over care for ill infants, and the disabled every year. We will battle over what we get to eat, how much we must exercise, and what risky hobbies we may undertake, because all of us are being forced to pay for our neighbors' choices. Thus our neighbors choices affect us. Government, rather than being a means of securing our rights against the war of all against all that exists in a Hobbesian state of nature, will have instead become the new form of the war of all against all. Our politics will become meaner; our social lives more petty and less caring. Liberals who whine that Republicans want to interfere in people's personal lives ain't seen nothing yet - if you are concerned about government in your personal life choices, wait until national health care arrives.
For six decades now, in good faith and in great confidence of the moral rightness of their position, liberals have sought to wrest control of people's health care. It is not just economic rationality, however, but also the desire for morality and common decency that impels opposition to the Obama/Pelosi nationalization of health care.
Cross posted from Politico's Arena