Raleigh

North Carolina Republicans, from U.S. Sen. Richard Burr to state Senate leader Phil Berger, say they are ready to fight to undo national health-care reform and keep government out of health care.

I have a simple question for them: Where were you 100 years ago?

The simple answer, of course, is that they weren't yet born.

But you'd have to go back at least that far to get government out of health care.

With or without new national health-care reform, national, state and local government has been heavily involved in the health-care system in America since horse and buggy days.

Most people are aware that Medicare, the health insurance program for the elderly, and Medicaid, the health insurance program for the poor, are creations of the federal government.

By the way, those two programs cover nearly 30 percent of the U.S. population.

In poor, rural counties of North Carolina, the numbers are greater. So, there's a reason that all the nice, new subdivisions in rural, eastern North Carolina are close to the hospitals. Medicaid and Medicare dollars course through those local economies and through those neighborhoods. They helped build the houses and pay the homebuilders, the plumbers, the electricians.

But government's reach into health care hardly stops at Medicare and Medicaid.

Most hospitals in North Carolina began life as public institutions, financed and built with the backing of local taxpayers. When the ribbon-cutting ceremonies were held, the folks handing over the keys to the new hospital administrators were typically county commissioners. The message was clear: County government and county tax dollars did this.

It's also worth remembering that North Carolina Memorial Hospital - today's massive UNC Health Care - isn't the product of free enterprise. It's a creation of state government.

The same is true of the medical school at East Carolina University, whose -creation is arguably the single most important action taken by the North Carolina General Assembly over the past 40 years.

The dominant medical insurer in the state, Blue Cross Blue Shield, also wasn't put together by some enterprising -business people looking to cash in on a market demand. It was formed with Duke Endowment money to fill a void that the private sector couldn't or wouldn't. Until 1986, the company was considered a -charitable organization exempt from most state and federal taxes.

Government also regulates health care at many levels, the most basic being the licensing of doctors and other health care providers.

The reason for all this government involvement is that most people don't view health care as a typical commodity or service. People see it as a right. As a society, we don't allow people who can't pay for care to wallow in a ditch and die. And we don't walk into a doctor's office and look at a menu of treatment options, the prices listed beside each, like we're at a Burger King.

If Burr or Berger believe they can undo all that, and create some free-enterprise health care system that has never existed, have at it.

Scott Mooneyham writes for Capitol Press Association in Raleigh. Contact him at smooneyh@ncinsider.com.