Health insurance is a hot topic these days. President Barack Obama has big plans to reform it, though his ideas are a bit fuzzy. Congressional negotiators are trying to craft legislation to change it. All these efforts are premised on the notion that we need more government regulation and mandates to solve our health insurance problems. But considering that health care is already highly regulated and heavily funded by the federal and state governments, we should ask if further political involvement would reduce our health care problems or add to them.

All Americans, even those with good health insurance, know that the health insurance marketplace does not work well. Premiums are high, coverage seems arbitrary, and few understand exactly what all the health insurance forms mean. So when there are proposals to drastically reform the system - or establish a government-run insurance company as an alternative - it sounds appealing. It's got to be better than what we have, right?

What's worrisome about increased government intervention in health care is that many of the problems in the health insurance marketplace today can be traced, in large part, to other government interventions in health care. Many regulations have dubious benefits for consumers, but they drive up prices and force consumers to buy policies that cover a wide variety of services they may neither want nor need.

For example, even if you do not plan to have children, the state of Maryland mandates that all insurance plans that it regulates must provide coverage for in vitro fertilization. Likewise, Maryland requires that insurers cover contraceptives and Chlamydia testing. Many people question the scientific merits of chiropractics and acupuncture, yet Maryland requires that the insurance plans it regulates cover those practices.

These mandates are great for fertility specialists, acupuncturists and chiropractors, but they're difficult for people who want affordable health insurance that covers their needs.

Maryland politicians have imposed 66 mandates on health insurance policies. As a result, many insurers stay out of the state-regulated markets, limiting insurance choices for individuals and small businesses. That is why more than 90 percent of health insurance policies sold to individuals or small businesses in Maryland are by two companies. Even Maryland's liberal politicians recognized the problems caused by these mandates and have taken a commendable if insufficient step by allowing a limited mandate-lite insurance policy to be sold in the state.

Annapolis defends these mandates by claiming that they protect the public from insurance companies, but in reality they are doing much more to protect the health care providers who offer the mandated services. The mandates are just another way businesses try to game the political process to fatten their bottom line.

Unfortunately, any government-run insurance program would operate in much the same way. Decisions about what this plan should cover or what its rates should be would be influenced by those with the most money at stake in the process. When politicians make decisions about health care procedures, no one should be surprised that politics will play a large role in those decisions.

Before creating an expensive government health insurance program, President Obama and Congress should consider enhancing consumers' freedom in the health insurance marketplace. If Congress were to allow Americans to purchase health insurance across state lines, Marylanders could avoid the mandate and force insurers to compete more heavily on both price and coverage.

We don't need more government involvement in health insurance. Current government involvement already adds to our dissatisfaction with the current system. President Obama and Congress should take a step back, refrain from adding to our ballooning national debt, and instead give consumers the power to purchase health insurance that meets their needs, not the needs of special interest groups and politicians.

Marc Kilmer is a senior fellow at the Maryland Public Policy Institute. His e-mail is

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