Prepare the expulsion hearings: I'm very friendly to Charles Murray’s plan to essentially socialize most of the cost of health care, but leave it’s provision in private hands. Before the vote to expel, let me explain:

The proposal is contained in Murray’s “In Our Hands: A Plan to End the Welfare State,” which recommends replacing all welfare, Medicare, Social Security, etc. with a single annual stipend of around $10,000 paid to every adult, phasing out above a $50,000 income. Around $3,500 of this would be an annual health insurance voucher, which everyone gets regardless of income.

Murray’s research suggests that with several basic reforms this would provide a lifetime, high-deductable, catastrophic care policy for every person. Among those reforms are ending the “licensure/scope-of-practice Raj,” and making negotiated liability waivers enforceable. The $3,500 voucher wouldn’t cover extraordinary end-of-life expenses, but individuals could use their own money to buy such coverage. Or not, and just surrender gracefully when that time comes.

Certain things that don’t make sense in the current system do when everyone gets a voucher. One is universal community rating – if everyone has insurance then there’s no “free rider” problem, and thus no justification for punishing individuals with higher rates for suffering the “cosmic injustice” of being chronically unhealthy. The issue of “individual mandates” becomes moot – everyone gets the voucher.

Here's why I find this proposal appealing: Limited government purists insist that Medicaid creates the same perverse moral hazard incentives as other forms of welfare, but I don’t believe it's possible to address that with the same eliminate-the-entitlement model that worked for welfare reform. The fact is, Americans just will not step over the bodies of ailing-but-curable indigents and say, “Sorry pal – you made bad choices.” We will pay to treat them, and all our movement's (correct) assertions that "health care is not a right" won't square that circle. This is part of why Murray calls health care sui generis – a reality not encompassed within any wider concept.

In the 19^th century Americans chose to not allow any child to not be educated. We made a huge mistake then, socializing not just the cost of schooling but also its provision. The school choice movement is all about reversing that error. Today, Americans are coming around to an analogous decision regarding health care. I believe that’s inevitable. In consequence, the limited government movement's greatest contribution may be to ensure that even if we socialize most of the financing, the provision of health care will remain within the private sector.