Heading into the 2008 presidential campaign season, the issue of healthcare reform is second in importance only to the war in Iraq, according to most voter polls. If past performance is a reliable indicator, and assuming philosophical convictions will not be changed overnight, the proposals we can expect to see from both major parties will attempt to expand the role of government and circumvent the principles of economics.¹

For Hillary Clinton, the candidate who has tussled with healthcare most publicly issues in the past (and "has the battle scars to prove it"²), the answer is universal health coverage. The same goes for John Edwards, only a little more aggressively, and Barack Obama, only a little less aggressively. Republican Mitt Romney stuck people in Massachusetts with a reform act that makes the purchase of health insurance compulsory. And while both John McCain and Rudy Giuliani claim to reject the idea of an individual mandate, neither has proposed replacing any of the major social institutions with meaningful free-market alternatives.

In terms of principles, none of the leading candidates is far from agreement with Senator Edward Kennedy—who has suggested that the United States government expand Medicare to include nearly every man, woman, and child, regardless of age—yet no candidate wants to associate themselves explicitly with that part of the political spectrum.

Observers eager to see sweeping change lament that the reason healthcare reform has been a non-starter over the past fourteen years is due to "ideological gridlock."³ But competing personalities in Washington is not what is holding back national healthcare reform. Both parties have shown repeatedly that they are willing to compromise their position in exchange for broader voter appeal in the center.

This is ideological convergence, not gridlock. The unstated goal is to obfuscate the true nature of the issue and create an illusion of "consensus of the experts," which brushes alternative arguments (such as those for laissez-faire) aside. As Ayn Rand identified:

"In order to win, the rational side of an controversy requires that its goals be understood; it has nothing to hide, since reality is its ally. The irrational side has to deceive, to confuse, to evade, to hide its goals. Fog, murk, and blindness are not the tools of reason; they are only the tools of irrationality."⁴

The holdout against such ideas as universal coverage and the "right" to healthcare largely comes from the vestige of an American sense of life, still present in many people, which holds individual rights as irreproachable and opposes government-run medicine as immoral. These pro-individualist convictions are either being eroded or outshouted this campaign season—it is not clear yet which. But if they cannot be revived on a larger scale and be heard, then we will end up with one or more of the current proposals for reform, and our problems will multiply.

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¹ For an example of an attempt to circumvent economic principles, consider President Clinton's plan in 1999-2000 to institute price controls on prescription drugs and insurance premiums as a means of lowering costs. The reasoning contained in the proposal was so faulty that in March of 2000, over 500 economists signed an open letter attesting to the inevitable failure of such an approach. That letter is available through the Independent Institute.

² This is a folksy line that Ms. Clinton uses in many of her speeches on healthcare reform. See transcripts on the official Hillary Clinton campaign website for examples.

³ Altman, Drew. "Issue of healthcare heats up," Boston Globe, July 9 2007

⁴ Rand, Ayn. "The Anatomy of Compromise," Capitalism: The Unknown Ideal, Signet 1967

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