The challenge in health care policy is to keep what works, discard what doesn't, and don't adapt practices that will make things worse.

Michael Tanner, of the Cato Institute, addressed a committee of the Wisconsin General Assembly. He gives a balanced view of both the good and bad in the American health care system.

"By almost any measure," he says, "if you are diagnosed with a serious illness, the United States is the place you want to be. " On the other hand, he says, "while the U.S. provides the world’s highest quality health care, that quality is uneven and too often Americans don’t receive the standard of care that they should."

The occasion for his remarks is the legislature's consideration of the "Healthy Wisconsin" plan. It's a coercive system, in that (nearly) everyone must join, and you lose your current insurance and choice of doctor and other medical professional.

He warns that costs may soar under the plan. One reason: it could have a deluxe, supersized version of mandated benefits-- "a virtual blank check and an open invitation for special interests to seek inclusion for their specialty or disease."

The plan nods toward competition, of the "managed" sort, which means that any competition "is strictly at the margins." The plan, furthermore, would not adjust premiums for age, sex, or risk. This is likely to lead to "overprovision of care to the healthy and under-provision to the sick."

There are other things to not like about the plan, but as Tanner points out, legislators are significantly restrained by the federal income tax code. Among his recommendations for what the state can do: promote price competition among insurers (allow purchase of out-of-state plans, for starters) and among providers (by loosening restrictions on who can provide what services).