It's not about insurance...

Masked by the political persiflage of the '08 Campaign is the quiet realization that the health care issue is really, really about controlling costs - not extending coverage.

After more than a decade in the wilderness, health care has returned to the center of the political discussion. But the only topic getting any serious attention is universal health insurance. It’s the entire point of the ambitious new program in Massachusetts and a similar proposal in California. Universal coverage has dominated both the news media’s coverage of the Democratic presidential candidates’ reform ideas and the candidates’ own jockeying over those ideas. [More of an insightful article]

The underlying problem is painfully (no pun intended) obvious. We cannot afford, individually or collectively all the health care we think we need. Worse still, we don't need much of what we want.

Trying to sort these two ideas out will be the challenge. Our cultural obsession with medicine as the fix for bad choices complicates our thinking. Insurance masks the reality of health care by foisting the costs on third parties, penalizing those who by virtue genetics, luck or behavior need less care. This insulation is both seductive and destructive.

Ultimately, I think we are headed for a collision of cultural values. We prefer insulation to real insurance. We expect services to be readily available, without the supply limitations or waiting lists that exist in countries where government is responsible for more health care funding. And yet we are growing increasingly concerned over the expansion of health care spending that takes place in a system that lacks constraints on either supply or demand.

Real health insurance may not be popular now. But when Americans see that the providers of insulation, including Medicare, have to turn to the rationing of health care services in order to meet budgetary constraints, real health insurance may start to look like a good alternative. [More]

This is a discussion we can't avoid forever. And it may turn out less rancorous than we fear. Our powerful economy is making such decisions a little less painful every day.