The perils of Big Doctor

AS A FORMER federal employee and the son of a federal worker, I love government - limited government.

When I was in that job in the Clinton years, my very wise boss used to say that when the politicians gave us bureaucrats a limited mission and limited resources to achieve it, we could do great things.

But when the politicians gave us unlimited resources, we'd waste them. And when they gave us unlimited missions, we'd overreach into unlimited failures.

I was thinking about that as Congress nears passage of health-care reform, extending government's reach with thousands more pages of rights, regulations and subsidies over a sixth of the economy. It's no accident that even as President Obama's health reform nears passage, his popularity plummets.

Under George Bush, a basically centrist public tired of a crusading president who committed unlimited blood and treasure to remaking Iraq and Afghanistan. Now, that same public is questioning President Obama's even more extravagant vow to revolutionize the $2.2 trillion health-care industry.

The problem: There seem to be two Obama presidencies, one moderate, the other revolutionary. Foreign-policy Obama is a careful, methodical man who reappointed Bush's defense secretary and works comfortably with incrementalist generals and admirals.

This Obama is a realist like Richard Nixon, not an idealist crusader like Reagan or George W. Bush. The Obama administration has cut back on Bush's efforts to spread democracy, and done nothing to discourage the crackdown in Iran and the slow-motion genocide in Sudan.

His autobiography, "Dreams from My Father," suggests that Obama's foreign policy reflects his considerable time spent abroad in his father's Kenya and his stepfather's Indonesia. From that experience, Obama believes the U.S. lacks the knowledge and will to democratize the world. Accordingly, foreign-policy Obama is a model of modesty (perhaps too much so).

Yet domestic President Obama shows no such reserve, with an economic "stimulus" spending $250,000 a job, bank bailouts, auto takeovers and health-care reinventions. Here, the president is influenced less by personal experience than by his time at Columbia, Harvard and in Chicago among liberal policy experts who overstate the ability of government to manage society.

Unfortunately, in the real world, professors and bureaucrats often get it wrong. And even when we get it right, that doesn't mean that we earn legitimacy.

An example came last fall, when the government advised against mammograms for women in their 40s, partly on grounds of cost. The public and pols were quick to denounce the recommendations, and the administration immediately retreated.

This is just the beginning. Particularly for the elderly, medical innovations are outpacing our collective ability to pay for them, as noted in a recent Newsweek cover story with the macabre title "The Case for Killing Granny." The ugly fact is that, inevitably, health care will be rationed.

Either the insurance companies or the government will be making decisions about when and how to pull the plug on the very old and the very sick. It is a political reality that whoever makes those decisions will not be popular, and that politicians will find it almost impossible to say no.

To the extent possible, I want those rationing decisions made in the private sector, by the traditional private options, albeit with public regulation and subsidies for the poor. As a patriotic American and an ex-federal employee, I'd rather people hate their insurance companies than their government.

Robert Maranto (rmaranto@uark.edu) is the 21st Century Chair in Leadership at the Department of Education Reform at the University of Arkansas, and recently co-edited "Judging Bush" (Stanford University Press), and "The Politically Correct University" (AEI Press).