The pragmatic reason for opposing a nationalized health service arises naturally from the fact that they just don’t work well, as we have seen in Canada and in the UK.  Philosophically, opponents of single-payer health care worry that once the government pays for our medical care, it will have the authority to dictate lifestyle choices to its citizens subjects day-care denizens.  Paul Hsieh points out how this has already begun to happen in Japan for the Christian Science Monitor:

Imagine a country where the government regularly checks the waistlines of citizens over age 40. Anyone deemed too fat would be required to undergo diet counseling. Those who fail to lose sufficient weight could face further “reeducation” and their communities subject to stiff fines.

Is this some nightmarish dystopia?

No, this is contemporary Japan.

The Japanese government argues that it must regulate citizens’ lifestyles because it is paying their health costs. This highlights one of the greatly underappreciated dangers of “universal healthcare.” Any government that attempts to guarantee healthcare must also control its costs. The inevitable next step will be to seek to control citizens’ health and their behavior. Hence, Americans should beware that if we adopt universal healthcare, we also risk creating a “nanny state on steroids” antithetical to core American principles.

Do you still think that diet and exercise choices are no one else’s business?  Not when other people pay your medical bills.  If I have to pay for my neighbor’s doctor bills, I’m going to demand that he stops smoking, stops eating pizza five nights a week, and starts getting some exercise.  If necessary, I’ll find a way to make him stop.

Of course, I won’t have much power to enforce the Ed Morrissey Rules on him, except to not pay his medical bills.  Replace me with Uncle Sam, and suddenly we have the massive power of the state behind those rules.  How has that worked in other government-run systems?  Hsieh gives us a few examples:

• Britain banned some egg advertisments from television because they promoted an “unhealthy lifestyle.”
• New Zealand refused entry to a British citizen and submarine cable expert because of his obesity.  After he lost some weight, New Zealand finally relented — but his wife is still persona non grata because of her weight.
• The German government has campaigned to brand those who don’t eat right and exercise as “antisocial” for burdening the nanny state with their problems — which has certain uncomfortable historical echoes.

Don’t think it could happen here?  Los Angeles and New York City have already banned restaurants from cooking with trans fats.  A few California communities have banned smoking in private residences, which should be a real joy to enforce, and some states have sugar taxes on soft drinks.  That’s without a nationalized health service.

He who pays the piper calls the tune.  When we surrender our responsibilities to ourselves in favor of a nanny state, don’t be surprised to be treated like children … or worse.