Michael Gerson

For some of us, the problem is not the tyranny but the nagging. As the public role in health care dramatically expands, health care controversies become politicized. The health enthusiasms of a president, an influential congressman or an interest group can become public policy or public pressure. After all: "Look what's happened on other issues Congress felt strongly about."

This is one of the reasons that the health care debate is not going away. Initially, some Democrats hoped the public would be quickly converted to the virtues of health care reform -- a hope that died amid growing public disapproval. Now Democrats seek to change the subject with a populist assault on Wall Street. But this lacks minimal credibility, precisely because Obama focused public attention almost entirely on health care for nearly a year and a half instead of pursuing financial reform.

The health care issue will not fade, because Obama has opened a raucous debate on the size and role of government that he cannot simply close. America is experiencing an outbreak of political philosophy. It is like the Constitutional Convention -- except that the participants are throwing food at each other and making rude gestures. It is like the Federalist Papers -- in comic book form.

There is no doubt that the American health care system, in some ways, has been an unholy mess -- a collection of perverse incentives, costly practices and gaps in coverage. Democrats seek to rationalize the system. But when the federal government imposes rationality -- writing insurance regulations, mandating the individual purchase of coverage, cutting the disbursements to doctors and hospitals, requiring calorie disclosure at the Burger King drive-through -- the power of government necessarily expands. Is government even capable of rationalizing a complex system on this scale? Even if it is, is the possibility of a more organized, rational system worth the risk of abuse?

In a country where there is a record level of distrust in government, skepticism on these questions is not surprising. Obama's overreach on health reform has created an unexpectedly broad opposition coalition, including independents and conservatives, people who fear that health costs will rise and the quality of care will fall, and people who fear that the Federal Reserve is controlling America through fluoridation.

And those of us who fear apples at Easter.

Michael Gerson

Michael Gerson writes a twice-weekly column for The Post on issues that include politics, global health, development, religion and foreign policy. Michael Gerson is the author of the book "Heroic Conservatism" and a contributor to Newsweek magazine.
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