Earlier I wrote about the Obama administration’s possible backing off of the inclusion of a so-called “public option” in health care legislation. But what’s important to emphasize is that even without the creation of a new government plan, we could still be stuck with a government-run health care system. First off, at this point, we don’t know how this idea of a non-profit co-op would work — under some versions, it could easily become a de facto government plan. Even setting that aside, however, the reality is still troubling. The remaining parts of the proposals in Congress would leave us with a system in which government mandates that individuals buy insurance or pay a tax and that employers offer insurance or pay a tax. Then government would have to define what constitutes insurance. Medicaid would be expanded dramatically. The government would be providing subsidies to individuals to purchase insurance, but even if individuals don’t qualify for subsidies, at least under the House bill, they would be forced to purchase their insurance from a government-run exchange. And though the policies offered at this exchange would be nominally “private” they would be designed by government bureaucrats. In the Senate Health Education Labor and Pensions bill, a new Medical Advisory Council would be tasked with defining “qualifying” coverage; in the House bill, all Americans are required to have coverage that is deemed “acceptable” by a Health Choices Commissioner. No doubt, the creation of a new government-run plan is the easiest way for the country to evolve into a pure single-payer system, but even without one, the proposals being considered would give us a system in which individuals would be forced to purchase government-designed insurance polices from a government store.