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Welcome to Choice-i-stan

I think it’s time to retire the word “choice” from public policy discussions – at least the one concerning medical insurance. To see why, let’s take another public policy issue that isn’t as freighted with political inference: Roads.

Imagine putting the notion of “choice” to work on paving the public thoroughfares. We could give property owners the “choice” and the “right” to pave the road in front of their property.

So what happens?

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Owner A chooses to go first-class all the way, with top-grade materials, engineering and construction; paving a piece of road that will, like the Apian Way, last millennia.

Maybe owner B does a cost-benefit analysis and constructs a road that meets the need for safe, convenient travel at the best possible price.

Next door, though, Owner C who bought the house on speculation wants to invest as little as possible for the greatest return. He chooses a great-looking paving job that will start deteriorating in two years – when he’s moved on.

Owner D puts down gravel on his section, asserting that gravel roads were good enough when he was a boy in Koder Leshaj, Albania.

The cheapskate on the block, Owner E, doesn’t pave his section at all, figuring that his neighbors will become so frustrated with the resulting tire and vehicle damage to their cars they’ll pave it for him.

Residents of the apartment building on the corner get to enjoy the road-paving choices made for them by the building owner who lives in Palm Springs.

It’s easy to see that the result of this arrangement isn’t a road that does what we expect a public road to do – make it reasonably easy and safe to get from one place to another.

Eventually we hope that the people in this hypothetical example will recognize that it’s in their mutual interest to have serviceable roads to their properties and share the cost – also called paying taxes. They might even hire someone to manage the ongoing maintenance of their road, so they can pursue their own businesses instead of being in the road-paving one.

And chances are that they’re going to have to strong-arm a few people into supporting the public good.

No doubt malcontents will find a friendly welcome at Alex Jones’ PrisonPlanet.com, sport “Don’t Tread on Me” bumper stickers, or work for Ron Paul’s perennial presidential campaign. All while happily driving on the well-paved road their tax dollars pay for.

As someone at a higher risk of complications from influenza, it is a matter of my self-interest to reduce the possible sources of infection. The more people out there with untreated contagious diseases, the more likely I am to get them. And the more likely I am to get them – just like ruining tires on an unpaved road – the more costly the consequences.

I might not, for example, be able to afford a new dress from your store or dinner at your restaurant. Or real estate prices could collapse as armies of baby boomers succumb to flu complications and their properties flood local markets.

If you think that my road-paving example is far-fetched, take a walk back in Santa Clara history with me. While today Santa Clara rightly prides itself on the quality of its paved roads, a century ago there was significant opposition to public investment in paving city streets.

The effort to pave Santa Clara’s city streets began in 1912.

“The next three years will be the most important in Santa Clara’s history, and a successful foundation for the city’s future cannot be too long delayed,” wrote the Santa Clara News’ Henry Roth. “For this reason the Town Trustees, have earnestly discussed the advisability of paving the streets of the town in preparation for the 1915 Panama-Pacific Exposition when millions of visitors will inspect every foot of Santa Clara’s beautiful valley.”

Not everyone shared Roth’s view of this civic enterprise. “A large number of the property owners on the streets to be paved are meeting against the improvement,” reported the May 15, 1915 San Jose Mercury Herald. “It was decided to distribute protests in the parts of town to be paved to be signed by the property owners against the contemplated improvement.”

Caroline Franck, daughter of city father Frederick Franck was a foremost opponent of street paving of any description; reportedly saying that, “if God had wanted the sidewalks paved, he would have done it himself.” History doesn’t record whether Miss Franck extended her principled objection to interference in divine providence to the operations of the fire department established by her father.

Ultimately, as we know the streets got paved – and so far without the city being imperiled by socialism or government tyranny. However, our ancestors’ seemingly irrational objections to progress should be a caution to us today.

Perhaps we should ask ourselves how our opinions about public issues such as universal medical insurance will look a century from now. Will our descendents see us as wise stewards of community welfare, or reactionary crackpot anecdotes in city history?

Certainly, our own health matters as much as well-paved roadways.

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Kaiser Permanente

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