Today, after a bit of a hiatus, our conversation with Bob Graboyes, the senior health care advisor to the National Federation of Independent Business, continues, with an attempt to get Bob to share the NFIB's view of the presidential candidates' health care agendas. In the time since this interview was conducted (by email), the terrain has shifted. On the Democratic side, Sen. Barack Obama seems to be consolidating his hold on the nomination, though Sen. Hillary Clinton remains in the race. Meanwhile, Republican Sen/ John McCain has completely reconsidered his own platform, unveiling an overhauled policy proposal just last week.

In general, the Democrats have proposed a sort of "managed competition" for health care: people can keep their insurance if they like, or they can join a government sponsored plan, "the same coverage that members of Congress enjoy." Employers would either have to provide insurance or pay the government to do it. (As the largest employer in the economy, the government has leverage few others could match and a pool big enough to absorb the risk of the currently uninsured.) To read about Clinton's plan, click here and here; for my take on her dispute with Obama over mandates, go here.

Finally, if you need to catch up, previous installments in this series are collected here.

INC.COM: What does NFIB think of the "managed competition" proposals that the Democratic candidates have proposed, where subsidized government-run coverage competes with private insurance?

GRABOYES: I'm not going to critique the proposals of candidates from either party. We're proactively and positively reaching out to all the campaigns, engaging them in conversation about the needs of small business. We're working as an organization to help shape policies that benefit small business and the country as a whole.

INC.COM: Why is the NFIB so reluctant to embrace a government role in providing health insurance, especially considering that in the NFIB's vision the government would guarantee a minimum of coverage and presumably help pay for it?

GRABOYES: As I mentioned in my answer to another question, NFIB has endorsed guaranteed access, as opposed to a particular guaranteed level of coverage. But NFIB is certainly not opposed to a government role in providing health insurance. Medicare, Medicaid, SCHIP, the Indian Health Service, Hill-Burton, EMTALA, and a slew of other programs exist and we're not opposed.

INC.COM: Why isn't a more expansive government-based system good for small businesses -- after all, it would keep their employees healthy and it wouldn't cost them nearly as much as those who provide coverage now pay?

GRABOYES: I disagree vehemently with your premises on both health and costs. Single-payer systems do some things better than we do, but we do some things better than they do -- and on balance, I think the latter is more frequently the case, though that's partially subjective. American health care may deny someone a transplant because she has no insurance, whereas that might not be an issue in some country with universal coverage. On the other hand, America treats and saves extreme low-birth weight infants who would never be treated in some countries who proudly proclaim "health care for all." Americans expect rapid treatment of illness, while Canadians and others expect longer wait times for treatment -- and sometimes waiting kills. Some nationalized systems place rigid age limits on who is eligible for treatments such as kidney transplants.

International data suggest that government-run health care would not be cheaper than our current private insurance. Compare the original estimates of Medicare's costs (recalibrated into current dollars) with the actual costs. Look at the growth of health care costs in Canada and other single-payer countries. Explore the hidden costs implicit in single-payer system: the job-killing tax rates necessary to finance Canadian health care, for example. The humorist P. J. O'Rourke said it best: "If you think health care is expensive now, wait until you see what it costs when it's free."


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I should point out to you, as I did to Bob, that his refusal to discuss the Democrats' health care initiatives strikes me as quite one-sided, because he did talk at length about interstate association health plans and individual tax deductions, which are mainstays of the Republican health reform agenda -- including, at the time, that of John McCain. In a follow-up email, I asked Bob whether Hillary Clinton's proposal to help small businesses to cover employees was the sort of compromise that the NFIB's members might favor, but he wouldn't go there. Today the question is beginning to look moot.

Our Q&A concludes next week with a discussion on how people who can't get health insurance today would be able to buy it under the NFIB's principles. Stay tuned!