We've had competition in health care, and it has not led either to lower costs or better care.
People who need and "consume" health care hate the current system. Doctors and health care administrators hate it.
Insurance companies, however, are digging it.
This notion that we can have a government which is not involved in business and the provision of the necessities of life is just ludicrous.
Over the past 150 years, business and corporate entities have taken an ever-greater role in supplying the fabric and texture of everyday life. Transportation, power, communications, banking, the food supply, utilities, health care.
Our government would topple in short order if any of these networks failed: "government" needs them because we need them. That argues for government interest in them. Further, most industries have proven that they need outside regulation if they are not to become monopolistic and abusive.
If we the people need what business and industry provide, and government relies on business and industry to provide it for us, then who is to oversee, regulate, and shape the activity of business and industry, if not our government of the people, by the people, and for the people?
In the modern era, government and business are joined at the hip. I don't see any practical way they CAN'T be.
What is at issue is exactly how that necessary relationship is negotiated, the nuts-and-bolts details of how to regulate, reward, punish, or shape a particular industry to get a particular desired societal result.
Figuring that out is our only option.
We have big government (and no one has grown it bigger than Reagan and Bush). We're a big country, with lots of we the people and lots of big business, and we NEED a big government.
It IS the government's duty to assure the common welfare. It doesn't HAVE to do it directly, but it is surely responsible for creating the conditions by which common welfare is assured – for creating opportunity for individuals and groups to make their daily bread by providing something of value to others.
Those conditions result from the fabric of laws governing incorporation, interstate commerce, the banking system, taxation – laws created by a duly constituted government charged with creating an economic system.
And when the common welfare is not substantially served by indirect means, when the opportunities of some infringe on the wellbeing of others, then government has the responsibility, on our behalf, and out of our general public wealth, to take up the slack directly.
The American "free enterprise" system (which has, of course, been less than entirely free from the gitgo) has worked for many Americans, much of the time. But in every era there have been specific ways in which it did NOT work, Americans who were left behind and left out of the general prosperity. In every era, some industries have become clearly abusive, utterly subordinated public interest to private profit. In every era, people have said "there ought to be a law" to constrain this abuse or that one. And in every era, the formulations of law have been tinkered with, and rightly so: the body of American business and corporate law circa 1850 could not possibly suffice in 2008.
When I hear the "smaller government" mantra, I always wonder what size government we're supposed to go back to, and what we're really prepared to give up to get there.
Business and industry have ALWAYS operated on the playing field government created for them. As far as I know, pictures of American presidents and not corporate CEOS or business icons are still on our money.
Maybe we should abolish what elective and representative government we have, and turn everything over to corporations, and see where truly unbridled free competition gets us.
but I was merely commenting on the poverty issue. 
