WASHINGTON, D.C. -- I remember testifying before the Revenue and Taxation Committee of the California State Assembly about 10 years ago on behalf of a bill to establish tax credits for Medical Savings Accounts. Liberals, of course, grasp at any straw to oppose the idea of MSAs, but I was thunderstruck when the chairman of the committee said that he worried that "doctors would see these accounts as pots of money and run up their fees accordingly."

There has seldom been a better example of the biblical story about the need to remove the mote in your own eye before noting the speck in your neighbor's, for it is exactly the pot of money in Medicare and third party private insurance that has driven up health care costs over the last 30 years. Worrying about the potential pricing effects of relatively tiny MSAs is a bit like worrying about catching a cold in a brothel.

But the fear of choice and private market power is still very much alive in Washington, where last year's budget deal contained an incredible proviso effectively prohibiting doctors from treating patients on a private contractual basis. Under the law, any doctor who negotiates privately is banned from the Medicare system for two years. Since nearly every doctor treats some Medicare patients, this proviso effectively outlaws private medical contracting. (Which begs the question: Now that we're protected from predatory doctors, who will protect us from predatory congressmen?)

A few Republicans were roused from their somnambulism long enough to notice this egregious breach of every principle of liberty imaginable, and a few have made some effective noises of protest. Arizona Senator John Kyl is trying to force a complete rollback of this obnoxious proviso, but is so far losing the war of the soundbite to California Rep. Pete Stark, who is defending the new rule with a semi-satiric bill entitled "No Private Contracts to be Negotiated when the Patient is Buck Naked Act." (It is being called the "Stark Naked Act" for short, though neither title is as punchy as the bill dealing with Asian royalties on American music sales back in the 1970s; that bill, co-sponsored by Rep. Fong and Senators Spong and Russell Long, was known naturally as the Fong-Spong-Long Hong Kong Song Bill. It passed, and the Clerk of the House was spared the embarrassment of having to read the bill three times quickly.)

What is nakedly on display here is just how much residual strength the idea of government paternalism still has. The outcome of this debate has implications for many issues beyond health care. If we can't be trusted to behave as consumers in the market for health care, how will Congress deal with Social Security reform when the time comes? It is a stark prospect indeed.

--By Steven Hayward