In government as in life, there is always a tension between those who find themselves unprepared for unexpected misfortune and those who are fortunately prepared for misfortune, expected or not.

The latter have sacrificed to pay ever-increasing health insurance premiums; the former are those who gamble that the taxpayers who paid the high cost of insurance, or those who took a job at lower pay for the assurance of coverage, will sacrifice even more by paying even higher health-care costs.

Is it right to choose cell service rather than Blue Cross? Should the young and the reckless, the imprudent or the illegal, assume they will receive care at the local emergency room, utilizing the bankruptcy court as the bill payer of last resort?

The root of our health-care problem is really our own humanity. God will not permit us to turn away a bleeding accident victim at the trauma center door, even if neither his car nor his body is insured and even if his immigration document is not in proper order.

A lawyer would tell us not to tackle the problem, because "hard cases make bad law." But still we must try. Many of our hospitals and more of our patients will continue going bankrupt without some solution. The question is, "Which one?" Republicans and Democrats come from different approaches. And the choice of approach will affect our own survival when, heaven forbid, insured or uninsured, we are among the patients bleeding at the trauma center door.

Democrats would have the "government," i.e. taxpayers, become America's insurer. It is the Kennedy/Clinton/Obama approach championed by the activist left and narrowly avoided in the last Democratic administration.

It utilizes a combination of government cost controls and rationing. Bureaucrats would decide what procedures were appropriate and which were too costly for the federal budget to bear. Taxes would be raised to pay for the program, taking money "from each according to his ability and giving benefits to each based upon his need."

The only problem with the Democrats' presentation of the idea is that they have once again plagiarized the work of Karl Marx and Neil Kinnick without giving them proper credit. The buildings might be government-gray, the doctors might be underpaid, but everyone would wait for mediocrity together.

Alternatively, Republicans believe in a well-regulated but free-market approach. The Republican idea is that government exists to police corrupt business practices, but not to run businesses.

Wide Choice Needed

Ever since Theodore Roosevelt began using government to "bust the anticompetitive trusts," Republicans have fought for reasonable business regulation to ensure competition, but opposed government operation of free business itself.

In the health-care field, this means that Republicans want to give Americans a wide choice, but a free choice of private, well funded, and reasonably priced insurance.

Essentially, health care is like any other commodity. Government needs to make sure it is safe, but the free market is the only mechanism that can ensure that it is plentiful and therefore can be consumed at a reasonable cost.

The Democratic approach follows the socialist model of Canada and the United Kingdom. In order to control costs, care is given to what the government considers the most needy, and physicians are paid for their services as little as politically possible. Physicians would then be forced to organize into labor unions, occasionally striking or going through "slowdowns" in order to force higher wages.

The government, both the health provider and the doctor's employer, would then ration services to balance against the cost of health worker demands. It is a world where the "masses" are beholden to the State. Lenin would be proud of our progress.

A free-market approach is dramatically different. The government would regulate the quality of medical training and the competence of hospital staff, but would also welcome the development of new medical schools and the opening of new hospital beds.

Physicians and hospitals would be free to improvise in order to compete better for the patient's business and that of his insurer. Cost would be controlled by an increase in the supply of medicine, enough to keep up with the rising demand. To make insurance more affordable, taxes would be lowered, not raised. The consumer would buy insurance. The government would not create it.

An aging population and an explosion in expensive lifesaving innovation has left America with a dilemma in health care, not much different from the crisis in energy.

Democrats want us to conserve and ration each drop of oil and each hour of a physician's time. They want us to make laws to control cost while developing less energy and providing less health care. Republicans want to produce more doctors and a greater variety of insurance and even drill for more oil.

This leaves government to do what it has historically done: Ensure that supply is adequate and competition is honest and fair. Sometimes that is done well and sometimes not, but it is what democracy requires and what the markets need to ensure their ordered liberty.

Protection From Greed

In some respects, the free market must always be protected from the inherent greed of charlatans who spend their Sundays dreaming ways to steal prosperity from those who use the day to seek a path to salvation. That is the proper role of a government which cherishes the choices that a free market provides.

But when the qualification to run health care is a degree as a "master bureaucrat" rather than a degree as a medical doctor or Master of Business Administration, then our health care will never become as good as our physicians. It will only become as good as our politicians, and that is not good enough for what is now, for all its flaws, the finest health-care system in the world.

John Owen, of Pinehurst, is chairman of the Moore County Republican Party. Vice Chairman Robert M. Levy contributed to this article.