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Empowering Individuals or Bureaucrats?

The choice and the contrast in health care.

By From the May 2012 issue

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ALSO IN CHOICE SYMPOSIUM

James Piereson
A Time for Choosing


Stephen Moore & Peter Ferrara
The Road From Serfdom


David N. Bass
The Millennial Perspective

In March, as the Supreme Court considered the constitutionality of President Obama's partisan health care law, the American people saw an event that could mark the end of bureaucrat-controlled health care. At the same time, just across the street in the halls of Congress, they witnessed a powerful reaffirmation of the American Idea as the House of Representatives passed the Path to Prosperity—a budget for the federal government.

The interconnectedness of these two events cannot be understated. Taken together, they have refocused a long-overdue debate about the proper role and scope of the federal government. This debate will undoubtedly continue in the months ahead and build to a crescendo in November, when the American people will have the opportunity to make a defining choice about what kind of nation we will be in the 21st century.

Perhaps no single issue crystallizes the choice before the American people and the contrast between the two parties more than health care. The differences between the President's bureaucrat-centered model and the model advanced in the Path to Prosperity, which champions choice, competition, and individual control, could not be clearer.

The bureaucrat-controlled approach to health care may have begun with the best of intentions, but it quickly ran into the same problem that it always does: bureaucrats are terrible at setting prices in a market economy. As the federal government's control over health care grew, bureaucratic mistakes started to cause serious problems. Government subsidies drove up costs; and health care became unaffordable for those who didn't qualify for them. As a result, rising costs now threaten to leave our children buried under a mountain of debt.

As it usually does, this approach called for more and more power to be ceded to Washington in order to solve this problem—and for the first time ever, the unlimited power to force Americans to buy something. The result was "Obamacare."

The President's health care overhaul is emblematic of the wrong way to address the problems in health care and Medicare. The law raids Medicare by nearly $700 billion to fund a new, unsustainable, open-ended health care entitlement. It creates a government panel of bureaucrats with the power to impose price controls on providers in ways that would result in rationed care and restricted access to treatments. It vastly expands an already unwieldy administrative state by creating 159 new boards, commissions, and government programs. It is built around the flawed assumption that bureaucrats, if given power over the marketplace, can curb rising health care costs by expertly determining prices and dictating treatment options to doctors and patients.

Ultimately, this approach transforms the relationship between citizen and state, leaving individuals increasingly passive and dependent on their government. Further, it substantially diminishes the quality of and the access to care, as future policymakers cut costs to meet budgetary bottom lines rather than patients' medical needs. There is no way for "experts" in Washington to know more about the health care needs of individual Americans than those individuals and their doctors know, nor should bureaucrats second-guess how each individual would prioritize services against costs.

The "fatal conceit" of the health care law stands in stark contrast to America's historic commitment to individual liberty and personal responsibility. And the Supreme Court's deliberations showed indications that the bureaucrat-centered approach is just not possible in America.

Our Constitution restricts the federal government to certain limited powers, and reserves all other powers to the states and the people. Our Founders trusted the American people, not an all-powerful federal government, to act in their own best interests. They trusted these actions would result in the greatest good for all. Their trust paid off: America became the greatest force for good the world has ever known.

The new health care law, which asserts unlimited power for the federal government to decide how Americans should get their health care, simply is not compatible with the Constitution.

In their deliberations, the Justices of the Supreme Court also raised a very salient point: If this is the end of bureaucrat-controlled health care, what comes next?

House Republicans showed them with the passage of Path to Prosperity, which offers a new approach—one that maintains a critical role for government but ultimately puts the American people in charge, as they should be.

For the second year in a row, Republicans in the House outlined a better way forward in health care. Our budget repeals the President's health care overhaul and keeps the protections that made Medicare a guaranteed promise for seniors throughout the years.

To the bureaucrats who have mismanaged the program into bankruptcy we say: Enough. Your approach doesn't work. Government has never come up with a magic formula for lowering costs and improving quality. It's time to put 50 million seniors, not 15 bureaucrats, in charge of their own health care decisions. Forcing insurance companies to compete is the only way to guarantee quality, affordable health care for seniors that will last for generations.

Implementing these reforms in Medicare can have the effect of lowering health care costs for everyone; and that's the answer to the question, "What comes next?"

Our budget shows there are leaders in Washington committed to building on this bipartisan consensus for patient-centered reform. It shows how we can increase affordability for everyone, while preventing government debt from threatening the health security of seniors and the economic security of all Americans.

Putting our trust in the American people—and this goes beyond health care—is what our budget is all about.

We get government bureaucrats out of the business of picking winners and losers in health care and other critical sectors of the economy. Instead, we trust the American people to make their own decisions about what kind of cars to drive or what light bulbs to use.

We give power over safety-net programs to the states, and tell governments that are closest to the people: We trust you can do a better job than the federal government designing these programs so that they actually meet the unique needs of each community.

We lower tax rates by closing special interest loopholes, making clear Washington doesn't need to micromanage people's decisions through the tax code. We let hardworking taxpayers keep more of their hard-earned dollars, and trust them to decide how to spend it.

It is so rare in American politics to arrive at a moment in which the debate revolves around the fundamental nature of American democracy and the social contract. But that is where we are.

The President's approach gives more power to unelected bureaucrats, takes more from hardworking taxpayers, and commits our great nation to a future of debt, doubt, and decline. This approach is proving unworkable—in our Congress, in our courts, and in our communities.

The contrast between the President's approach and ours could not be clearer. We put our trust in citizens, not government. Our budget returns power to individuals, to families, and to communities.

The Path to Prosperity represents a vote of confidence in the American experiment. Putting our trust in the American people will hopefully renew their trust in us. Americans should control their destinies—and we trust them make the right choice about the future of our country.

America is on the wrong track, and the President's approach is bringing us toward a debt crisis and a welfare state in decline. As leaders, it is our obligation to offer the nation a better way forward, and we have. We are offering the nation the opportunity to realize a brighter and more prosperous future, in a way that's consistent with our founding values. And we do so with confidence that, as they have countless times since our nation's founding, the American people will make the right choice and preserve the American Idea for generations to come.

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About the Author

Rep. Paul Ryan, the Republican candidate for vice president, is a Congressman from Wisconsin and the chairman of the House of Representatives Budget Committee.