07/17/2012 01:34 pm ET Updated Sep 16, 2012

The Democratization of Health Care: Smallers Call for a Round Three

The Supreme Court's decision on the constitutionality of critical provisions of the Affordable Care Act brought to a grinding halt in the second round of the great American health reform debate. The first round culminated in President Obama signing the bill into law. The small government community (Smallers) is now orchestrating a round three, a November plebiscite -- because they cannot believe that a majority of Americans, given the direct opportunity, would really vote to reform the system so that 38 million of their fellow citizens can have access to health insurance.

Health insurance is essential. It is the medium through which the promise of health and medical services is transformed into life-sustaining care and treatment. You cannot help but notice, when you walk into a point of care (physician's office, hospital, pharmacy), before you meet with a professional or receive any services, you are greeted by someone who politely demands your health insurance card. The card evinces the ability to pay and communicates which products and services you are eligible to receive, at what price, for how long, and the copayment for which you have personal liability. Of course, the consumers and providers are free to negotiate services and financial arrangements outside of what is reimbursable under the terms of the insurance plan. But that rarely occurs.

Private insurers have never been able to price an insurance card that every American can afford. Most non-senior adults get their cards as a part of their employment compensation; but more and more employers are reducing wages by eliminating health insurance. As a consequence, a decreasing percentage of Americans are covered through private insurers. And there is every reason to believe that the private insurance market will continue to shrink without ACA, putting more Americans at risk to become uninsured.

It is against this headwind that Smallers want the American public to follow their ideological lead by repealing ACA and accepting their promise that a non-federal solution to the uninsured problem will materialize. When pressed, they suggest that we could allow medical insurance to be sold across state lines, presumably meaning that competition will reduce the cost of insurance so that the broad reaches of the uninsured will be able to buy a card. They also offer up tort reform, apparently believing that by limiting medical liability damages, the cost of insurance will drop to levels that will allow the masses to purchase health insurance. They are persuaded that consumers will whip out their voter identification cards and vote for their promise over the practical realities of ACA.

The federal government as an insurer does not necessarily lead to the evil (a government takeover of our health care system) that Smallers inveigh against. Many of us who support the expansion of health insurance coverage are against a government-run health care economy. It is not in the public's interest for government, or private insurers for that matter, to be the dictator of prices, establisher of distribution networks, and arbiter of who has access to what and when. That said, we need government-supported health care because private insurers cannot price a product that all Americans can afford to buy.

The Smallers must accept market fundamentals and redraw their battle lines. They would have a much broader and more diverse constituency if they moved away from effectively advocating that 38 million Americans remain uninsured, and towards a more constructive leadership role in guiding the formation of government-supported, health care financing that allows free-market principles to remain the driving force in our health care economy. Government insurance and a free-market health care economy are not polar opposites. In their rage against ACA, Smallers have so super-heated the environment that constructive conversation has given way to sloganeering and hyperbole. Yet it needs to be asked: If government is the dominant insurer, how can we give consumers and providers the greatest latitude to interact so that a dynamic and thriving market place survives the reforms? What the nation needs is a health care economy in which free-market principles and government-supported insurance naturally coexist.