From the moment man was self-conscious (or, if you like, from the moment he emerged out of the state of nature) he faced a political choice something like this. He could have rule by the one, rule by the few, or rule by the many. Those exhaust the options. This is a basic question of political science.
America, almost alone among nations, has sent forth a bold cry for rule-by-the-many, which means self-rule, since her earliest days. Our political tradition stands emphatically for rule-by-the-many, for popular government, for democracy; our nation is a republic.
I submit that this health care reform bill is a very considerable step away from rule-by-the-many and towards rule-by-the-few -- both on the level of state-capitalism, where we have established near-monopolies, and on the level of bureaucratization, hard on the heels of which will surely follow corruption on a vast scale. We have further "managerialized," if you'll forgive a jargon term, our society.
Now, I hasten to add that because America has, historically, stood for rule-by-the-many, and very boldly at that, does not make rule-by-the-many ideal or even best. We ought to separate our love of country from our estimate of the science. Of course Americans tend to think rule-by-the-many is the best way; many of us appear to think it is the only reasonable way. Objectively this is not so. Many reasonable arguments have been given, by many a serious thinker, for aristocracy or for monarchy, or for some principle of minority dictation. In the last few months star columnists at The New York Times have written admiringly of China, a nation unapologetically founded on a plutocratic or managerial or rule-by-the-few framework.
So someone is free to answer me: "well medicine is one area where we must have planners," or "let's face it that the managerial model ain't so bad when it comes to health issues." I will not gainsay that answer (for now), except to state that it has departed, at least in certain important particulars, from the American tradition of rule-by-the-many.