The current controversy surrounding state initiatives to mandate vaccination of preteen girls with the human papillomavirus (HPV) vaccine sheds light on what is wrong with our health-care system.

The great economist Milton Friedman pointed out the problem. Noting that everything seems to get cheaper while health care keeps getting more expensive, Friedman explained that the problem is that the person buying health care is most often not who is paying for it.

Most medical services today are paid for either by insurance companies or the government. In fact, The Wall Street Journal recently reported that government now pays for 45 percent of our health-care bills.

If you don't know the price tag of what you are buying, how can you know how much to buy? And, if someone else is picking up the tab, how do you know when to stop?

A few days ago, pharmaceutical giant Merck announced that it was pulling the plug on its nationwide lobbying campaign to get state legislatures to mandate that preteen schoolgirls receive its vaccine, Gardasil. It protects against some strains of HPV that may lead to cervical cancer.

Company officials stopped the campaign because of a nationwide backlash fueled by concerns that it is premature to mandate a new vaccine that has many unresolved questions regarding efficacy and safety; and that, in any event, it should not be mandated because the virus is transmitted through sex and not through casual contact, and that parental rights were being violated.

The Merck spokesman who announced the decision said: "Our goal is about cervical-cancer prevention, and we want to reach as many females as possible with Gardasil."

Who would question the goal? But the spokesman left out two key points. At what cost? And who makes the decision to purchase the vaccine?

Merck's answers here are simple. Regarding cost, as much as it can charge. In this case, about $400, or about eight times the cost of a measles vaccine. Regarding who makes the purchase decision, its preferred answer is the government.

Let's take a different example.

It's straightforward that bigger, heavier cars are safer than smaller, lighter cars. But they are also more expensive and consume more gas.

Certainly safety is a major factor considered when a family purchases a car. Family members will evaluate their ability to pay for more size and more gas in order to get more safety. In the end, they will make a decision that reflects their own tastes and tradeoffs. They might even wind up driving more carefully as result of buying a smaller, lighter car than they might have preferred.

Suppose, however, a politician decides that we can't leave these decisions to individual consumers, but, in the name of public safety, government will mandate that everyone must buy a bigger, heavier car. And if you can't afford it, the government (i.e., taxpayers) will pay for it.

Do you suppose the result will be poor decision-making and a lot of waste? Continued...