Supreme Court subtleties notwithstanding, conservatives must find a way to refocus the health care debate on two questions that constitute the true rock-bottom essence of the issue: (1) Do you own your own body? and (2) Do you own your neighbor's soul?

Republicans, like their nominally conservative equivalents worldwide, have been far too easily dragged onto liberal turf on the health care issue.  Too often -- almost always, in fact -- they begin with the premise that the basic problems are "access to care" and "how to reduce costs."  From there, the debate devolves into the conservative case for "market-based solutions" versus the liberal argument that "health care is too important to be left to the free market."

Allowing the debate to be framed in this way has contributed mightily to the leftward ratchet that has moved this issue throughout the Western world for the past eighty years.  Continuing to accept this framing guarantees socialized medicine in America's future, whether through the intermediate step of ObamaCare or through some other conduit.

The folly is twofold.  First, by beginning with the collegial assumption that we are all in agreement on goals, conservatives cede the moral advantage in favor of implicit moral equivalency.  ("I completely agree with my good friend across the aisle that we must find a way to make quality care available to everyone, regardless of economic status.")

Secondly, by granting that the central issues are "access" and "cost-reduction," the right sacrifices the optics of the debate to the left.  For "allowing the market to work," while it is in truth the only way to reduce costs in the long run, sounds like the argument of an accountant, rather than of a concerned leader -- whereas "we have to take active steps to insure that all Americans have access to affordable health care" sounds like a moral position.  It isn't moral at all, but it sounds moral as long as all sides agree that access per se is the overriding goal.  In the court of public opinion, the person who seems to represent the moral, "public-spirited" approach to an issue is on the shorter track to victory.

The way to overcome this losing stance -- the posture of a man looking for a place to fall -- is to reject the customary way of framing the debate.  This will be difficult, as the issue has been presented this way by all sides, and of course by the media, for so long.  Nevertheless, it is high time -- past time, in fact -- for those who care about freedom to step firmly away from the "common ground" of the twin goals of "increased access" and "reduced costs."  It is time for conservatives to stand tall on the principle that the so-called health care debate is, at its heart, a debate over freedom versus oppression.

Which brings us back to the questions I posed at the outset.

First, who owns your body?  If the Declaration's invocation of a Lockean right to life means anything, it means that your existence as a rational animal is yours to preserve and dispose of.  Your living person is your first piece of property, the only one to which you are naturally born, and the ground and ultimate source of all subsequent property you may acquire.

Since you are the owner of your own living body, that body is yours to preserve by whatever means you are able to muster through your own efforts and voluntary interaction with others.  Freedom, at its most basic level, means your natural right to pursue your self-preservation without hindrance.

Clarification of this last point may be necessary for the benefit of those whose education has taught them that every man-made "entitlement" constitutes a new right.  Your right to preserve your life is not hindered or restricted by your practical failure to acquire satisfactory means to self-preservation through voluntary interaction -- not any more than it is restricted by your failure to acquire water from a nonexistent fountain of youth. 

Your right to self-preservation is restricted, however, by a human individual or organization that takes active steps to limit your ability to engage in the voluntary interaction that might lead to your continued or enhanced life -- e.g., by a criminal who bars the door to the emergency room, thus preventing you from seeking necessary care.

Government-controlled health care, whether on the fascistic ObamaCare model or the directly socialized model (to which ObamaCare was designed as a precursor), has as its purpose the artificial restriction of available options.  It makes no difference whether this is presented as a path to "fairness" or as a means of achieving "universal access."  In its effect, it thwarts the voluntary action through which men might pursue their self-preservation, by coercively limiting everyone to a single state-ploughed path to care.  In a government-run health care system, an individual's natural desire and right to pursue his own self-preservation, or that of his nearest and dearest, gets re-branded as an immoral scheme to promote the ultimate evil, "two-tiered health care."

Two-tiered health care -- the buzzword Americans will hear more and more of as the left gains further ground on this issue -- means simply that people are free to purchase the goods and services they are able to pay for.  If this seems "unfair" to you, then you have fallen for the modern framing of the debate described above.  Some people work, save, and/or borrow to buy a Porsche.  Others work just as hard, but have to settle for a little economy car instead.  And yet no one speaks of a "two-tiered auto market." 

If health care seems "different" to you, and it just seems wrong that some people can afford Porsche-Care while others can't, then you are welcome to start a philanthropic enterprise aimed at providing the most expensive health care and medicines to low-income families.  You would undoubtedly receive huge numbers of donations from decent people who like to contribute to improving the lives of others. 

But don't mistake that wish to help others for a political argument.  To do so is to answer "yes" to the second question I raised at the outset -- namely, "Do you own your neighbor's soul?"  The moment your hope to improve the health care lot of others becomes a claim against someone else's freedom to pursue his own self-preservation through voluntary interaction, you are clamoring for the state to restrict another man's -- not to mention your own -- natural right to life.  You are seeking to restrict his natural desire for life -- which is to say, you are denying him the moral status of an individual human being, an end in himself, reducing him to a mere means to others' ends.  Simply stated, you are refusing to recognize the dignity of his soul. 

In addition, you are willingly consigning ownership of his body, and ceding ownership of yours, to the state, which will henceforth have the exclusive right to decide when, whether, and on what terms "your" life will be preserved.  

Access to health care and the reduction of costs are legitimate practical concerns for any society; but they are secondary concerns, not the primary one, which is whether people are free to pursue their self-preservation by whatever voluntary means are available to them. 

As for the practical matters, it ought to go without saying that a free market -- a truly free one, not one carefully regulated to sustain the fortunes of powerful entities, or to sustain a budget-busting system of government "fairness" programs -- would achieve broader and more affordable care than any other economic model.  If the computer industry had been regulated thirty years ago in a manner analogous to modern health care regulations, on the grounds that computer technology was too important to be left to market forces, is there any doubt that people would have fewer, slower, and vastly more expensive computers today, if any?  Conversely, is there any reason to doubt that health care could have the same dynamic fate as the computer industry, were it not being stifled by endless regulation?

Nevertheless, all the good things that could be said about access and cost-reduction must be said from a fundamental presumption of freedom.  The "market-based solutions" talk gives away the heart of the issue, by rendering freedom just another one of the reasonable options on the table.  Freedom is the only option that can be acceptable.  Once that is established, one can get into the weeds about how to achieve the secondary goals, such as access and affordability.  In fact, once freedom to pursue one's well-being is established, one will hardly have to get into those weeds.  The market will do what it always does, when left relatively unrestricted.  It will elevate everyone's lot.

Will this lead to "equal" quality care for everyone?  Of course not; the nature of a dynamic market is progress (not Obama-style "progress," but the real thing), and this means that something new will always be available at a premium -- until it proves itself successful and desirable enough to be produced on a wider, cheaper scale.

The desire to restrict such dynamism in the name of a skewed, egalitarian understanding of fairness is just another manifestation of the envy and bitterness that define modern leftist psychology.

Don't fall into the rhetorical trap any longer, conservatives.  The health care debate you need now is not about the best way to achieve shared goals.  The contrast of goals is the debate.  One side is for individual liberty, and specifically for the natural right of self-ownership.  The other side -- well, the other side was summed up by Ronald Reagan more than fifty years ago.