Recommended: What the Health-Care Debate Is Really All About

I recommend James Capretta's piece What the Health-Care Debate Is Really All About on the Public Discourse website. Underneath all the rancor there is, indeed, a fundamental philosophical split between liberals and conservatives. Liberals believe in the power and wisdom of strong centralized government to manage almost all aspects of the nation's life. Conservatives distrust strong centralized government, and prefer to let free-market forces shape the nation. There are valid arguments on both sides, but in general I think history and the experience of other nations provides a stronger case for the conservative side under most circumstances.

At the root it is a matter of incentives. A free-market business has strong incentives to keep its customers happy. If it doesn't, it loses them and eventually goes out of business, overtaken by rivals who are better at the job. So a sort of Darwinian "natural selection" is always in operation, driving businesses toward better and more efficient performance, rewarding those that innovate successfully and eliminating those that cannot compete. Of course, sometime businesses game the system and distort the free market with cartels or other underhanded practices. But in general, the free market system is what has brought this nation to its position as the worlds foremost producer and innovator. European nations, which liberals seem to think are good models for their view of America, have in fact uniformly done less well economically. Truly centralized economies, such as those in Communist-era Russia and its satellites, have done miserably.

In contrast to a free-market system, government programs and government bureaucrats have no such incentives, no such "natural selection" forces driving them toward better performance. As a consequence government programs and services are almost always less efficient and less responsive to those they serve (as anyone who has had to deal with a Motor Vehicle Department lately already knows). Liberals like to point out that European-model health plans produce better results for less cost, and they are right. But they neglect to point out that people in such systems often wait months or years for a treatment that Americans can get in weeks, and are often unable to get access to expensive drugs or treatments that are available to Americans.

Our nation was founded by people who distrusted the big, centralized, overbearing governments they had experienced in Europe, and our government system was deliberately built to let the states retain as much power as possible, as a balance against big government. In a sense, this "states rights" approach mimics the free market, allowing the states freedom to all experiment with different systems. Ideas that work get copied by other states. Ideas that don't work (usually) eventually get dropped. We have eroded states rights steadily over the years, mostly under liberal pressure, and in general we are probably the worse for it.