Before the economy really took a turn for the worst, health care reform was at the fore for many voters. The high-rising costs and lack of coverage has fuelled calls for universal health care by the government. Usually these are expressed in emotional terms, accompanied by anecdotal horror stories. The typical riposte is the generic concern about socialism. However, beneath the rhetorical squabbling between partisans exists a robust debate over how to reform the U.S. health care system and whether the focus should be on cost control or coverage. There are two main narratives in the debate. The pro-coverage camp approaches the problem from a morality perspective. The mere fact that people lack coverage when they need it is a moral imperative to provide it. Those concerned with rampant health care costs approach the problem from a philosophical orientation around personal responsibility. If costs can be reigned in, the individual has more choice and control over their health. The two sides stand in stark contrast, and the issue has seemingly become dichotomized and irreconcilable. Both sides accuse the other of ideological myopia (i.e., âÄúThe Church of Universal CoverageâÄù), while dwelling in their own. Universal healthcare advocates âÄî even by their own admittance âÄî have become convinced by the belief it will be a panacea in itself. Some cost advocates cling tight to their anti-government control cards. That makes for quite the corrupted discussion over a very real problem. The United States has been a vaunted technical innovator in the field of medicine, producing life-saving procedures and technology. The Mayo Clinic and Johns Hopkins hospital are second to none worldwide. Though The United States spends more on health care than anywhere in the world ($2.5 trillion), it nevertheless lags behind in the rich world on many health benchmarks. Forty-six million Americans are uninsured (though critics point out this includes many healthy young people who have chosen not to buy insurance). Costs have been soaring. Drugs become ever more expensive, and the Food and Drug Administration that approves them is forbidden by Congress to use cost-benefit analysis. Doctors are paid by the procedure, which when coupled with the fear of being sued for missing a symptom, leads to many medical procedures being ordered unnecessarily. The health care industry spends 1/7 the average on information technology improvement, often resorting to using paper filing. The government passed regulation during World War II that was intended to control wage and price spirals. An unintended effect was a tax break for employers to offer health insurance. Experts calculate this subsidy to be worth $200 billion per annum and fuels health care inflation. Individual health plans receive no such break. Thus, people become dependent on jobs for coverage, and the high cost burden places American business at a disadvantage globally. In extreme cases, people face financial ruin. Visits to the emergency room are expensive. Chronic conditions require therapies and follow-up care are even more lavish. There is also a problem of capacity âÄî hospitals sometimes direct patients to others. Some cities already face capacity issues. Clearly, reform is needed. Pro-coverage advocates like to point to other nationsâÄô health systems, namely Canada, France and Britain, as models. These programs are universal and taxpayer-funded for less than what America pays. That is true but misleading. Less is spent on health because it is budgeted, not discretionary according to need. Care is rationed, and not all people get the care required. Cancer patients often wait months to receive treatment. People travel to the United States for treatment they cannot find at home. Analysts have said the U.S. health system is uniquely inefficient, so foreign juxtapositions can only go so far. Sober discussion of reform is needed. The government, thanks to Medicare and Medicaid, controls almost half the health insurance market, which is a significant presence. Employers make up another quarter. That creates a lot of room to open up the individual insurance market. The amount of deaths from medical errors per year far exceeds those from lack of insurance. Up until this month, Medicare actually paid doctors even when they (intentionally or not) harmed patients. It should have cost them their jobs. Furthermore, insurance coverage is not equal to better health. Lifestyle changes, from eating to smoking, could yield better health outcomes than focusing on coverage. Investment in more medical facilities would also be a boon. Tackling the tax credit to business will bring more flexibility to the insurance market. The hardships some people endure should not be under-exaggerated. But universal coverage seems a rather large symbolic way of âÄúdoing something.âÄù Some argue âÄúcover first, worry about the bill later.âÄù It must be recognized that universal coverage will come at tremendous costs, and would add to an already looming entitlement crisis. Traditionally, people funded health costs through debt taken against houses. House prices have been tumbling, taking the economy with them, and are not expected to reach bottom until 2010. Households already are on average 140 percent indebted, and will be much less able to leverage up if medical bills start to pile in unexpectedly. Whether that is reason enough for universal coverage is a question we submit to superior minds. Those at St. JamesâÄô Street welcome comments at [email protected].