When government tells restaurant owners that they can't let customers smoke on their premises, that's the nanny state. When it fines motorcyclists for not wearing helmets, again, the nanny.
But is New York City Mayor Michael Bloomberg playing Mary Poppins when he tries to stop low-income people from using their food stamps for Coca-Cola and other sugary, fattening drinks? He is not.
Bloomberg would not be standing between these New Yorkers and their cans of Fanta. But he would end the taxpayers' role as enabler of poor nutrition choices. There's a difference between a government ban on something and its refusal to subsidize it.
Such distinctions have been lost in the fracas over health care reform. How many times have you heard Sen. Phogbound warn that the new law would let government bureaucrats decide what medical care you may have?
The bureaucrats would do no such thing. They would tell you what the taxpayers will and will not subsidize. You are free to go out and purchase motor scooters that fly, ineffective drugs and x-rays till you glow in the dark. But you would have to pay for unauthorized items with your own money.
Here lies the hypocrisy energizing many of reform's most vocal foes. They profess to want big government out of health care. Then they turn around and blubber that the government might not pay for everything anyone wants — as though private insurers would similarly leave their cash registers open.
A volcanic surge of self-contradiction erupted over the law's plan to cut overpayments to private Medicare insurers. Consider this outpouring from Marco Rubio, the Florida Republican running for the Senate:
"One study found that the new law's elimination of a tax subsidy could result in as many as 2 million retirees losing their drug coverage from their former employer's plans."
In the same paragraph, Rubio writes, "We must repeal ObamaCare and replace it with free market solutions that will not place hardships on older Americans."
What hardships? The drug benefits under Medicare Part D already include a wealth of tax subsidies; the law would actually close the gap in coverage. The projected savings of $136 billion would buy medical care for sick, uninsured children — and all it would do to the elderly is require a few of them to pick up such minor expenses as eyeglasses and health-club memberships.
Marco, you are making me dizzy.
Let's talk about Provenge. This is a new drug therapy for patients with advanced prostate cancer. The catch is that the drug costs nearly $100,000 and appears to extend life by an average of only four months.
Ask your tea party candidates whether they back spending this kind of money for such little return. If they answer no, ask them whether they are therefore supporting government-run death panels.
By the way, Medicare will be considering whether it will cover Provenge on Nov. 17. If Medicare says "no" to Provenge, it will not be denying access to the drug. Patients and their families would be free to buy it, but they must write the check. One can even envision a market for private insurance covering drugs that government or private plans do not.
Now that's a free market solution. Programs that merely shovel taxpayer money into corporate coffers are something else. They're corporate socialism. (The Republicans' Medicare drug benefit was Lenin in a top hat.)
We've traveled the distance from small government subsidies for junk food to huge subsidies for extending lives. But the principle remains the same. Government telling you what you may not do or buy is one thing. Forcing taxpayers to foot the bill is something quite different.
ABOUT THE WRITER:
Froma Harrop serves on The Providence Journal's editorial board in Rhode Island. Her column appears in more than 200 newspapers and she is a regular guest on many television and radio news analysis programs.