Townhall.com, October 23, 2007

Senator Hillary Clinton and Rudy Giuliani lead the polls in their respective parties, but they are starkly divided on health care, a thorny issue in the 2008 presidential race. Their dispute centers on whether to expand or reduce government control of health care. It is an issue with long-term implications for America's health and prosperity.

Liberty-loving Americans have always feared the threats of government medicine to individual choice and health-care quality. But medical care is often expensive, and we recognize the need for some mechanism to help us share costs when they get too high for one family to bear on its own. For many years, Republicans and Democrats have sparred over the solution to these challenges.

Senator Clinton helped to cement the partition between left and right with her government-centered plan during the 1990s. Unfortunately, Republicans also tilt that way, dishonoring their own standard of small government and backing programs such as the Medicare Part D Drug Benefit - the biggest expansion of government welfare since LBJ's Great Society. President Bush and the previous Republican majority in Congress tried to create free-market options within a government structure, with questionable results. For example, the public recently learned that the government is not capable of auditing Medicare Advantage insurers.

To achieve "universal insurance," Senator Clinton wants to roll all private insurers into a government straitjacket. She would forbid them from pricing according to beneficiaries' risks, and prevent patients and insurers from figuring out by themselves what needs coverage. Clinton would put government price controls on prescription drugs but allow pirated medicines from foreign countries.

Rudy Giuliani's health care plan stands in stark contrast to Senator Clinton's, and it holds the possibility of blazing a new trail with particular attention to competition and consumer-driven reform - streamlining the private sector in health care, not stepping on it.

Giuliani's plan has been criticized by both sides because it lacks the sweeping rhetoric of "universal" health care. It would give all Americans tax breaks for health care, whether purchased individually or through employers. And it supports expanding health savings accounts (HSAs), already proving viable for Americans of all ages.

VIMO, an online health insurance broker, anticipates that 55 million Americans will purchase their own health care in the next three years, and the rise of low cost, consumer-directed health plans is likely to continue.

Giuliani's plan also honors the principle of federalism, and acknowledges state sovereignty in the reform of health-care systems. It would offer grants to states to encourage innovation, reduce costs, and enroll more uninsured citizens, while allowing Americans to purchase insurance across state lines.

Senator Clinton's solution to "bring costs down" with government mandates is like squeezing a balloon. One end shrinks under mandates, but the other explodes from government growth. Already, Medicare and Medicaid promise to break the backs of younger generations with steep taxes, and poor quality care for America's children, elderly, and poor.

Furthermore, growing government programs and innovators don't play well together. But our profit driven advances in medicine are proving superior to countries with government controlled health care. Last year a study in the journal Health Affairs reported that the United States came out ahead of European counterparts for innovative drug output, despite theories to the contrary.

If the big spenders, both Democrat and Republican, of recent years have taught us anything, it's that an empty promise of bigger, better government usually means an empty bank. There is plenty of room to improve the private market for Americans with more competition, sustainable lower costs, and more personal choice and savings.

Few Americans dispute that heath care reform is needed. In 2008, voters will have many opportunities to appraise the health-care positions of all candidates. So far, the approach of Hillary Clinton leans most on government. For his part, Rudy Giuliani's proposal pays the most respect to individual choice and the private sector as the keys to long-term reform.