The resulting government monopoly or near-monopoly on health insurance would stifle innovation, require bureaucratic rationing, and infringe on freedom. But it would also move American politics permanently leftward ... the inevitable disappointments and failures of a nationalized system would just as inevitably be blamed on underfunding, creating a bidding war that liberals would usually win ... the creation of a new system would make free-market alternatives look more radical to the public than they do now, because they would be more radical. The public’s aversion to risk, which now hurts advocates of liberal policies as much as it helps them, would only help them. So national health insurance could be a lasting political success for liberals even if it is a colossal policy failure; it could, indeed, succeed politically because of its failures.
First, let me note that the Ponnuru's assertion that we are headed towards some sort of national Canadian health care system is highly dubious at best.
Beyond that point though this is a case study in the clueless-ness that plagues the right in regards to our health care crisis and the real issues and concerns facing tens of million of American families.
We already have rationing, that's the whole idea behind managed care. Beyond that though we ration based on wealth, the richer you are the better care you get and the poorer you are the worse. The right has tried to scare the American public with threats of rationing in a "socialized" health care system for decades. It no longer works because the system the right is defending is so completely broken that Americans recognize that something dramatic must be done. Rationing based on need doesn't scare the American public, it simply sounds fair and equitable and the American public understands that our current system is anything but.
Ponnuru then moves on to discuss how "the inevitable disappointments and failures" of a national system would counter-intuitively prove to be a political boon to the left in America. Ponnuru doesn't seem to be able to comprehend that perhaps the inevitable disappointments of a national health care system would simply be preferable to the current catastrophe that we call a health care system in this country. A national health insurance system could be a lasting political success for liberals because it will be seen as colossal policy success by the American public.
The American public are not stupid, sometimes they come around a little slower than we partisans would like but they know when they are getting a raw deal. Health care reform will be delivered because the public has demanded it. Democrats will reap the political benefits because they have answered a public need with an effective policy. The right cannot understand that public demand for health care reform is a result of the terrible shortcomings of our current system. Until Republicans begin to address the real needs of the American public they will be in the political wilderness. No one cares about "the free market" when they are worried that grandma is going to lose her house because she has cancer or that their son will have to declare bankruptcy to cover surgery costs after his heart attack.
It reminds me in a lot of ways of the right's reaction to climate change. As far as they are concerned the problem doesn't actually exist so why bother to find solutions? Sure they throw out things like Health Savings Accounts to placate public demands for policy solutions but in reality they aren't trying very hard, they just toss out a new tax cut or tax credit and call it good. Well the public is telling you, very loudly, that it's not good and they want real solutions. For the time being the left are the only people in this country providing those solutions.