Debra J. Saunders

On Fox News Wednesday, Sen. Hillary Clinton told the network's Bill O'Reilly, "If we don't get universal health care, we will continue to bleed money." Funny. The more Washington politicians promise to control health care costs, the higher they go. As humorist P.J. O'Rourke famously said, "If you think health care is expensive now, wait until you see what it costs when it's free."

Clinton and Sen. Barack Obama both promise to provide access to health care for all Americans by mandating that employers provide or contribute to the cost of health plans for employees. Clinton would mandate that all uninsured adults buy health care; Obama has no "individual mandate." Both candidates would offer health care for all children, subsidies for adults and would require insurers to cover everyone, regardless of health.

Somehow they propose to offer and subsidize more health care without raising costs for the majority of Americans who already have it.

What next? Consume more calories, weigh less?

Both Democrats suggest that prevention will contain costs. But as the Washington Post reported last month, with a few exceptions like childhood vaccinations, health economist Louise B. Russell's 1986 work, "Is Prevention Better Than Cure?" found that "prevention activities tend to cost more than they save. Since the book's appearance, her observation has been borne out by studies of hundreds of interventions -- everything from offering mammograms for all women and prescribing drugs to people with high cholesterol to requiring passenger-side air bags in cars and shortening the response time of ambulances."

Of course, prevention is a wise course. It extends and improves the quality of people's lives. But in the real world, it costs money. And it's worth it.

How can Americans control health care costs? I asked Sen. Tom Coburn, R-Okla., an obstetrician and family medicine physician who prefers to be called Dr. Coburn. He answered that there are two ways to control costs -- through government, a la Clinton and Obama, who will have to rely on federal "micro-managing and (eventual) rationing," or through the marketplace, a la McCain. While the marketplace is not perfect, it beats rationing and bad regulation.

The McCain plan would provide an annual tax credit of $2,500 per individual or $5,000 per family. The idea is to encourage families to buy their own health care plans -- preferably plans that save consumers money when they follow healthy lifestyles and make smart economic choices.

Unlike Clinton and Obama, McCain would not require that insurers cover people with chronic illnesses. Instead, McCain proposes state "guaranteed access plans" for those patients.

Debra J. Saunders

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