As we have been reminded from the elections just concluded, the number-one item of concern with U.S. voters is health care.  The reason for people's concern revolves around the never-ending upward spiral of costs.  One huge factor regarding health care is never mentioned.  That is because making prices public would be kicking a hornets nest.  Making prices public would introduce competition and put at least some of the power of health care decision-making back into the hands of the people.  Making prices public would take away the most intentionally opaque economy any of us has to deal with in his lifetime.  Costs in health care are driven up not only because medical advances don't come free, but also because there is a veritable cabal of players who have no reason to charge less.

The Democrats just took back the House of Representatives.  Attempts to either bring back Obamacare or go straight to single-payer will follow.  We just concluded a cycle with a Republican House of Representatives.  Voters thought the Republicans would act as a pushback to government expansion into health care.  What we learned instead is that powerful lobbies all aligned in opposition to keep their piece of the pie.  In the forefront impeding health care reform is a federal government with its never sated hunger for money, power, and control.  The few Republicans who professed resistance and represented any hope of fighting this array of characters were soon rendered impotent.

The best argument these Republicans could have made was never brought out into the open.

Making prices public provides the opportunity for competition.  Competition is capitalism's secret weapon.  Efficiency and innovation are rewarded, and fraud, waste, and corruption are exposed when a consumer is offered a choice.  Of course, choice involves risk, risk by definition incurs "winners" and "losers," and losing when it involves your health can be risky.  The unfortunate "losers" make great copy for the mainstream media.  But not introducing economic reforms into health care isn't even a real choice anymore, as the current system is untenable.

Before you say that it is impossible to approach reform by introducing competition, remember that the number-one health concern in human beings is their teeth, and until recently, dentists were never involved with insurance, government programs, hospital corporations, hospital workers unions, or employee unions.  Interestingly, you've never heard a voice raised saying dental health is a human right.

Who pays for health care in America has evolved over the past 75 years.  It could be argued that this progression has generated a cartel of interested parties whose primary goal is to make pricing less and less transparent. 

One player in this cartel is hospital plan insurance.  The underlying impetus in the growth of this vehicle was the opportunity to improve the cash flow of the hospitals themselves.  Unlike other types of insurance, hospital insurance (represented by institutions like Blue Cross-Blue Shield) was granted exemption from most insurance regulation as long as its providers operated on a non-profit basis and did not restrict enrollment.  Additionally, the IRS deemed these companies exempt from federal taxation, as they were judged to be "charitable" organizations.

Another cartel member on the side of maintaining the status quo is the employer-paid health insurance industry and the interwoven employees unions.  This insurance was ruled a tax-deductible expense, with health care benefits subject to collective bargaining.

Medicare and Medicaid were introduced in the 1960s.  Doctors and hospitals initially decried "socialized medicine," but the avalanche of money into the system from this cartel quickly quieted the dissent.  With government money now the largest income for doctors and hospitals, an incestuous relationship grew between government and health care.  This led to political decisions overriding economic principles when deciding whether to keep skyrocketing costs down and failing institutions alive.

The legal profession has quite a lot at stake.  Malpractice lawsuits are filed at a rate 300 to 400 times higher than 50 years ago.

These forces have caused many trends that are unfavorable to consumers of health care.  Because hospital insurance paid for hospital costs, the hospitals were incentivized to provide more services.  It paid only if the costs were incurred in the hospital, so it rewarded the decision to admit patients.

Further dislocation of the patient and pricing resulted from employer-based health insurance.  Rather than a worker making the choice of the most cost-effective plan available, the employer makes that choice for him.  Additionally, health insurers don't use community and experience ratings like other insurance companies, instead scouring data on employees of a company, allowing a health insurer to cherry-pick companies with healthy employees.  (Sixty-five percent of uninsured workers work for companies with 25 or fewer employees.) 

We are no longer at a crossroads regarding health care.  Because of Medicare and Medicaid, not to mention the V.A. system, we have already made choices deeply trending toward a socialist overhaul of the remainder of health care.  To have any chance of avoiding a single-payer system, there would have to be a U-turn to even get back to the crossroads.  Reality thwarted those who voted a few cycles ago not to give the federal government all of freedom regarding how to spend our health care dollars.

This is a problem for those Americans who seek to keep a traditional view of the Constitution.  We have reached a point where we are no longer a nation whose politicians know they are debating policy as a means to an end.  We have become a country questioning the nature of its government.  In other words, our politicians are debating not the means, but the end itself.  We are challenging the foundational principles upon which our country was created.

The government intruding into total control of our health care choices exponentially erodes what individual freedom we have left.  The "living, breathing" idea of a Constitution that "can keep up with the times" and not be based on "tired ideas" formed in the minds of "dead white men" has taken over as the philosophical stance on the left.  The left knows that cost transparency and choice in health care are anathema to the goal of an ever expanding, powerful federal government.

The right, on the other hand, has not taken the initiative.  The right, the supposed defenders of the very Constitution that made the United States the envy of the world, is sitting on the best chance to make an argument for liberty.

The schism between the two sides could not be any starker, which makes the stances taken by both sides more entrenched and divisive.  If those on the right are ever to start winning the argument for the future of both government and health care, they need to stand for something and get brave.  After all, there is a great deal of evidence that single-payer health care has its own problems.

The Republicans let the opportunity slip last cycle.  You can be sure that the Democrats will be of one voice in riding this socialist, anti-American, competing sentiment toward single-payer health care for all it's worth.  Ready or not, the time to challenge them is now.