The raging health care debate "debate" is almost entirely devoid of facts, an issue on which I've previously posted. Instead of discussing fact, then, we tend hurl vague accusations, like calling the reformers "communists" (and you've GOT to see this). I "blame" Obama for this lack of specificity, but I realize that the vicious opposition mounted by huge self-interested insurance companies and health care providers might require that he not play all of his cards at this point. But isn't it odd that our politicians aren't at least clarifying the term "health care coverage" when they refer to national health care coverage? Defining this term would make a huge difference to the public reaction to any national plan. Here are two possibilities (though there are others): A) The national plan will offer gold-plated coverage much like the expensive United Health Care coverage I buy for my family through my employer. For the record, the pre-tax cost of this coverage is about $20,000 per year for my family. Is the Obama proposal to provide every citizen with this kind of coverage? If so, I can see why there is massive resentment to the proposal. Many working people can barely afford health insurance coverage at all, and the coverage many people do purchase is not nearly as comprehensive as the expensive coverage I purchase. Of course people who can can only afford to buy their own rudimentary policies will resent that the government might buy gold-plated policies for everyone else, including many highly irresponsible people. B) The national plan will offer a rudimentary coverage only. It will cover x-rays and casts for broken arms, but not heart transplants and expensive drugs that only marginally increase one's chances of surviving an illness. It wouldn't keep people suffering from terminal illness on life support when there is no reasonable chance that they would ever leave the hospital. It would cover only a small subset of the treatments covered by gold-plated policies. It might be akin to the Oregon Plan. I believe that there would be massive resistance to the national coverage described in A) but far less resistance to the coverage described in B). At least Oregon's legislators had the cajunas to specifically state what was covered under their plan and what was not (Oregon's prioritized list is available for all to see). Oregon had the fiscal responsibility to make certain that they could afford the level of health care to which they were committing. Oregon dealt head-on with the accusation that they were "rationing" health care; absolutely they were, just like private plans ration health care only to those who pay those high premiums. Both responsible and irresponsible health care plans "ration" health care. Therefore, it is not a criticism of any health care plan that it "rations" health care. Here are the guiding principles to the Oregon Plan:

In 1987, the Oregon Legislature realized that it had no method for allocating resources for health care that was both effective and accountable. Over the next two years, policy objectives were developed to guide the drafting of legislation to address this problem. These policy objectives included:

• Acknowledgment that the goal is health rather than health services or health insurance • Commitment to a public process with structured public input • Commitment to meet budget constraints by reducing benefits rather than cutting people from coverage or reducing payments to levels below the cost of care • Commitment to use available resources to fund clinically effective treatments of conditions important to Oregonians • Development of explicit health service priorities to guide resource allocation decisions.

Our national conversation regarding health care is so dysfunction on so many levels that it's hard to know where to begin. I'll make only one more point in this post, however. Opponents of current proposals often make accusations that there will be "death panels," indicating that some sick people will be allowed to die. As a nation, we need to grow up and deal with the fact that this happens every day in every hospital in the country: we shouldn't be allocating huge amounts of money to maintain pulses in people who have become living corpses. There are some families who "can't let go" no matter what (e.g., Terry Schiavo), and our national plan needs to have specific guidelines for these situations. In fact, every private insurance plan should have guidelines for determining when further treatment is likely to be futile and a provision for ending coverage at that point. The alternative is to make policies so horrifically expensive that many people can't afford policies that cover tratments likely to make an immediate positive impact on their lives. Only when we put these issues clearly on the table can we begin to have a real conversation.