I'm feeling really old fashioned and out of it today. Picking up the Philadelphia Inquirer, I saw this story about a Republican governor whose latest triumph is a bill requiring everyone in his state to have mandatory, private health insurance -- something it seems only the kooky Cato Institute opposes:

BOSTON - The most radical portion of Massachusetts' move toward universal health care - a requirement that all residents carry insurance - is giving indigestion to some who view it as a breathtaking expansion of government power.

"This is the first time in the country's history where simply by virtue of living somewhere you are mandated to purchase a product," said Michael Tanner, of the Cato Institute, a Washington-based think tank.

Supporters of the idea, including Republican Gov. Mitt Romney, cite the mandate as a pillar of the health plan because it forces individuals to be responsible for their health care.

Many conservatives are embracing the so-called individual mandate, but some liberals and unions are suspicious. They typically prefer assessments on employers, which the Massachusetts plan also includes.

AFL-CIO President John Sweeney called the mandate "unconscionable" and accused Massachusetts of taking "a page out of the Newt Gingrich playbook."

I'll refrain from making inflammatory remarks about how the German opposition in the early 1930s might have "triangulated" Hitler's antisemitism, because I think don't think it's helpful to analogize mandatory health insurance to Auschwitz. Why, for starters, most Americans' family doctors are not named Mengele! (Why, oh why, must I continue to be so goddamned nice?)

But praeteritio Hitler triangulation aside, the Romney move is certainly Hillary triangulation, as noted by Shawn Macomber in the American Spectator:

I do not expect Massachusetts Governor Mitt Romney to pull off an elaborate mask moments after signing a bill bringing universal health care to the Bay State, thereby revealing himself to be a certain senator from New York. (No, not Schumer.) In point of fact, during a lengthy chat with Romney for a profile that ran in the March edition of TAS, one of the first things the governor said when I broached the topic of health-care reform was, unequivocally, "I oppose the concept of Hillarycare," and then, "Republicans believe in health care, just like Democrats. We just believe the right approach is not a government takeover, but, instead, the application of free market principles."

Nevertheless, when Joe Klein calls Romney's health-care plan "rather remarkable" and Ted Kennedy is asking to be on hand for the signing ceremony and Hillary Clinton herself is weighing in favorably (i.e. not sarcastically frowning or smirking) and the New York Times really, really loves the idea...Well, fiscal conservatives can perhaps be forgiven for instinctively reaching for come garlic bulbs and a flask of holy water.

Doubtless, Romney's pursuit of an individual mandate system compelling those with the means (as determined by the government, which we all know has always been so in touch with ordinary peoples' lives) to purchase health insurance while simultaneously subsidizing the insurance costs of those individuals or families within a stone's throw of the federal poverty line is much preferable to a single-payer socialized health-care system freezing out competition and innovation. Actually, Reason's Ronald Bailey makes a persuasive argument in favor of the individual mandate system. The Heritage Foundation, Wall Street Journal and Investor's Business Daily have all made similar noises to one degree or another as well. Perhaps such a compromise is the only way to avoid a single-payer system disaster. It's politically smart, as well.

Alas. Ron Bailey did say it, over a year ago. To be fair to Bailey, he makes a very compelling argument that this would preserve the most economic freedom at the least expense, and the piece is a practical call to recognize reality. But here's a troubling assumption:

Even some Republicans are suggesting that mandatory health insurance be required for at least some Americans. Senate Majority Leader Bill Frist (R-Tenn.) recently argued that it is unfair to expect taxpayers to pick up the health care tab for the third of Americans without health insurance who make incomes over $50,000. "I believe higher-income Americans today do have a societal and personal responsibility to cover in some way themselves and their children," the senator said in a speech at the National Press Club in July.

But how is that an argument for mandatory health insurance? Isn't it simply an argument against the taxpayers picking up the tab?

I think the whole health care mess is so thoroughly riddled with communitarian assumptions based on existing government regulations and laws that it's tough to know where to even begin from a libertarian perspective.

So, as my own quirky libertarianism comes from my own quirky individualist perspective, let me begin with me. I am self-employed, and I have the type of insurance Ron Bailey thinks should be mandatory -- "a basic high-deductible catastrophic health insurance policy from a private insurance company." If I get cancer or some loathsome fatal disease, I'll be covered, because I don't want to be wiped out financially.

But why shouldn't I have the right not to insure myself? If I'm in the Bill Frist category, I don't think the taxpayers should be required to pay for the costs of my illness.

I don't think the "taxpayers" should pick up my health care tab either way. (BTW, wouldn't all taxpayers ultimately be subsidizing any mandatory insurance?) If I have insurance, they won't, but if I don't have insurance why the hell should they have to pay for my health care any more than they should pay my heating or grocery bills? If I don't have heat or groceries, I will die, right? If I don't go to the doctor, I may or may not die, right? So, why isn't there at least as much of a taxpayer obligation to pay for my food and heat as for my health care? Arguably, there is more.

What's wrong with Frist's thinking is that it's predicated on the assumption that there is or should be any obligation by the taxpayers to pay for any of these things in the first place.

Suppose I stop paying for my health insurance. That would mean I'd simply have to pay for trips to the doctor out of my own pocket. So what the hell is wrong with that? If I had to be hospitalized, and it became expensive, I'd be liable to pay the bills. If I didn't pay them, the hospital could sue me and force me to pay. If my financial sources dried up because of my illness or something, I would continue to be liable and there would be judgments against me. I suppose I could file for bankruptcy (just as I could file for bankruptcy if I ran up huge gambling debts I couldn't pay), but unless I became a public charge, I don't see why the taxpayers should have anything to do with it. And if I became a penniless public charge, then I wouldn't be in Frist's middle class category, would I?

I saw a lot of friends come down with AIDS. Some of them had health insurance, and some of them didn't. Ultimately, most of them ended up being public charges, and that's because the insurance would only cover so much, medicare eligibility would kick in, and they'd be taxpayer burdens. With a catastrophic illness like AIDS or cancer, huge bills can result from each hospitalization, and it can end up consuming the policy limits. I'm not sure how medicare eligibility works, but Frist's guy making $50,000 a year who gets a terminal illness isn't going to be employed for long (most likely his savings will soon be exhausted) and hospital social workers are usually in quite a hurry to make sure every last possible benefit is invoked.

NOTE: I don't think we're talking about uninsured rich people here. A rich man without insurance ought to simply pay the entire cost of his medical care, and if the taxpayers have to foot the bill for his illness, something very major is wrong with the system, and calling for more government regulation begs the question.

Under our quasi-welfare state, poor people are simply taken care of by the taxpayers. But how do we define poor? The middle class can be rendered poor because of disability or illness, and once they are poor they are poor. Is there an unstated assumption that because someone was once a productive member of society, he has no right to become poor?

I mean, is it more evil to become poor than to be "born that way"? Illness isn't the only way to do that. And I'm not convinced that state-mandated insurance of any variety is the way to prevent it.

In all honesty, I do think there is an assumption that self-employed people and small business owners are more evil than other people, because they are less regulated. Yet these people are the ones who take risks -- and I think even communitarians should recognize that they generally contribute more to society than those who don't take risks. Why shouldn't they -- of all people -- continue to be allowed to take risks? To not have health insurance is merely one of the risks they might take, and I have no problem with putting the onus on the risk taker -- to the same extent as any other citizen. If his health crashes, he'll have to pay. If he didn't have health insurance, he'll be wiped out. But aren't there a lot of other things that can wipe him out? Why single out health?

According to the Inquirer, Governor Romney analogizes the situation to requiring auto insurance for drivers:

Romney, a possible candidate for the 2008 Republican presidential nomination, has compared the individual mandate to car insurance, which the state requires for car owners. Massachusetts will also require everyone to have health insurance.

According to [Cato Institute's] [Michael] Tanner, that's a false comparison.

"Driving has always been seen as a privilege," he said. "This is making me buy a product simply by virtue of breathing."

Breathing is a risky business. (Especially now that Hillary is running the Republican Party . . .)

On the bright side, we'll all eventually breathe our last. Even if we don't have insurance.

UPDATE: According to Newsmax, Hillary Clinton is singing the praises of the Romney health plan:

In what could be a blow to Massachusetts Republican Gov. Mitt Romney's presidential aspirations, two Democratic White House hopefuls have offered preliminary endorsements for his health care plan, which would force small businesses to offer health insurance to all uninsured employees.

"To come up with a bipartisan plan in this polarized environment is commendable," Sen. Hillary Clinton told the Associated Press on Thursday.

The Romney plan, which has already been passed by the Massachusetts legislature and is waiting the governor's signature, mimics in some ways Mrs. Clinton's own Hillarycare proposal, which crashed and burned in 1994 with disastrous political consequences.