By PHIL GRAMM

For every dollar's worth of health care that Americans received last year, they paid a dime and somebody else paid 90 cents. If you bought food the way you buy health care—where 90% of everything you put in your basket was paid for by your grocery insurance policy—you would eat differently and so would your dog. We have the best health-care system in the world, but as rich as America is we can't afford it.
Any real debate about health-care reform has to be centered on solving the problem of cost. Ultimately, there are only two ways of doing it. The first approach is to have government control costs through some form of rationing. The alternative is to empower families to make their own health-care decisions in a system where costs matter. The fundamental question is about who is going to do the controlling: the family or the government.

President Obama and his congressional allies systematically excluded every major proposal to empower consumers to control costs. From beginning to end, they insisted on a government-run system. That's why compromise was never possible.
The plan signed into law by the president on Tuesday is simply a hodgepodge of schemes to expand insurance coverage and government power with no coherent program to control cost. By contrast, the old Clinton health-care bill was a plan to control costs through health-care purchasing cooperatives, standards of medical practice, and penalties for providers who violated those standards. When Americans came to understand the loss of freedom resulting from the Clinton plan, they rejected it. The Democrats learned from that experience. This time around they simply left their cost control component to be added later.
Even though the Obama bill became far more unpopular than the Clinton bill ever was, the daunting size and rigid commitment of the Democratic majority to a government-run system was such that they could override public opinion. Now the Democrats are out to make Americans like their plan—or at least get them to acquiesce to it. But as Gandhi once explained, 40,000 British troops cannot force 300 million Indians to do what they will not do.
Republicans have a job to do. They must make it clear to the American people that this is only the beginning of the debate. There will be two congressional elections and a presidential election before the government takeover is implemented in 2014.
I believe that Republicans should take the unequivocal position that if they are given a majority in Congress in November, they will stop the implementation of the government takeover. And if a Republican is elected president in 2012, they will do with Mr. Obama's health-care bill what the American voters will have done to the Democrats: throw it out. If the voters demand change in November, even the Democrats who remain in Congress will help give it to them.
If Republicans don't want America to follow Britain and Canada down the road to socialized medicine, they must change the system so that families have more power to control their own health-care costs. This will entail real changes like tax deductions for health insurance, not for prepaid medicine; refundable tax credits for families to buy their own insurance; freedom to negotiate with insurance companies; rewarding healthy lifestyles; tort reform; and reforming Medicare and Medicaid so every consumer has deductibles and copayments based on their income. This system will require Americans to make choices in health care—just as they do in every other area of their lives.

There is one more overwhelming reason freedom is so critical in health care. In the end, even the greatest health-care system in the world fails. At 92, my mother decided to stop going to the hospital, stop going to the doctor, stop taking her medicine, and to die in her own bed. It was a free choice, and she made it. For her family, it was a painful choice, but she died as she lived—proud and free. Government bureaucrats did not make that decision; she did. And that made all the difference.