First things first . . .

Eventually we must get real.

The current national debate about health care is the latest issue that demands that we, as a people, get honest with ourselves.

There are conservatively around fifty million people in the United States not covered by medical insurance. Perhaps those people can get simple medical treatment at a clinic or emergency room. But for anything more serious, treatment is out of reach.

The beautiful thing about having this debate couched in complex terms and arguments of private vs. public, individual payor, universal care, government vs. private, socialist vs. capitalist, is that the necessary underlying assumptions can be avoided. There is always something in such complex debates that will give us safe cover from doing anything.

The question must be asked, are we who can afford medical insurance willing to accept change so that all can be covered? It is a simple first question, because it seems, at least in the beginning of such a plan, that most of us will have to accept some changes.

Yes I know it is not that simple. There may be some economic advantages to bringing the uninsured into the system where they can be treated in facilities other than emergency rooms and have access to earlier and preventative care. I hope that is true. But those economic advantages may not pan out in real terms and certainly not immediately. So the question still remains, are some of us willing to pay more so that all can obtain reasonable medical care?

It may be that the costs of medical care in America are artificially high due to the fairly recent conversion of medical care from a profession to a corporate profit cash cow. Maybe this issue can be addressed and the costs of medical care can be brought down. But the thing about cash cows, they are really hard to kill. More often they are milked dry until they are of no use.

But that's the way it is right now.

Which means, if we want everyone to have access to reasonable medical services, some of us will have to pay a little more and maybe accept changes in the medical care system.

Is that something we want to do? Or not?

That's where we should start.