The many elements of health care reform are mind-bogglingly complex, but there are some simple questions that anyone hoping to address it needs to ask first.
Are we a country that believes everyone equally deserves certain services and protections?
Is quality health care one of those rights everyone can expect or a privilege reserved for the few?
(For purposes of this discussion, we'll define the fortunate ones as those who carry insurance that's adequate to one degree or another. The unfortunate are obviously the millions who are uninsured.)
Do the fortunate have a right to state-of-the-art treatment at all times, while the others make do with medical care that is substandard (or sometimes non-existent)?
Should everyone get decent treatment, even if that means the well-off can't get the MRI-on-demand they've come to expect? Do the poor have less of a right to comprehensive diagnosis?
No matter how hard the politicians try to gloss over it, they will have to deal with these questions.
Even if all the improvements and efficiencies work as reform advocates promise -- and they won't -- a more equitable system would still mean millions more people will have access to it. For that reason alone, there will be longer lines of those waiting for the care they expect.
We will have to redefine not only what they can expect, but what they deserve -- what services are delivered and, just as importantly, which ones are not.
Not everyone who gets that MRI these days really needs it. Someone will have to be more discriminating about who does and who doesn't.
For that matter, not everyone needs the redundant tests that doctors prescribe, largely to protect the doctors', well, you know. Someone will have to come up with ways to help make sure that physicians' "well-you-knows" aren't in such danger of lawsuits, while still allowing the legal system to protect against shoddy treatment.
Someone will have to push preventive care to avoid the need for treatment. (Easier said than done.)
Someone will have to make sure hospitals clean up their acts and provide proper care in poor neighborhoods along with the more affluent ones.
The someones who will see their superb, anything-goes care questioned will have to pay more for an everyone-gets-it system.
Someone will have to make sure care-givers are much more selective in choosing treatments, as opposed to the knee-jerk choice of the most expensive one, when a less costly treatment would do just as well. The same goes for prescription drugs.
All of this could be a bitter pill to swallow for those who like things the way they are.
Call it rationing, call it whatever you want, but there will be decisions about what health care is available to whom and how fast it's delivered.
In fairness, we have a lot of that already, courtesy of insurance companies that simply refuse coverage when they damn well please.
Even so, it comes down to a basic question: In spreading the health, are we willing to spread the wealth?