Some comments to Ilya's post on Brink Lindsey reminded me that I get puzzled when I see libertarian and conservative think tanks (and individuals) go ballistic whenever anyone suggests having the government require "universal health care." See, e.g., the controversies in Massachusetts and California. It seems to me we already have universal health care; by federal statute, anyone has the right to show up at any hospital emergency room in the country, and get whatever care they need regardless of their ability to pay. Now, admittedly, this is an especially dumb kind of universal health care, because it neglects primary care, focuses on especially expensive emergency care, and turns emergency rooms into family physician's office (except, to avoid draconian liability under federal law, emergency rooms will be much more eager to order every possible test under the sun, lest they be accused of neglected their federal law obligations). The costs of such care, along with whatever other costs to the health care system the uninsured are able to pass on (bills not paid, contagious diseases spread, whatever), are paid by the rest of us, as surely as if they came out of the tax system. Moreover, healthy individuals who rely on the safety net for their care instead of paying for their own insurance (as well as employers who don't provide insurance) are free-riding on the rest of us. I'm against socialized medicine, and I'm against a single-payer system, (and I'm against Medicare for that matter, which not only subsidizes many well-off rich, but could hardly be better designed to waste money if it were done intentionally), but I simply can't get up in arms about "universal health care." We have a version of it already, but it's just a stupid and counterproductive version, and I'm willing to listen to alternatives that are less costly and more efficient, even if it means that the government is more directly involved, as with employer mandates.