Ross Douthat is Correct

Today he presented a coherent case that the political debate on health care will continue for decades.  Although in one respect he was focused on Heritage Foundation/RomneyCare/ObamaCare, he was really discussing the reality that we have a huge unfunded liability in Medicare and really need the Grand Bargain that Obama and Boehner tried to craft a couple of years ago.

Unfortunately, you cannot solve Medicare without solving Medicaid and the cost that uninsured individuals place on Medicare.  How do the uninsured transfer costs to Medicare?  By going to the hospital where they have to be treated and having their uncollectible debts become part of the cost structure that the insured (and that includes those on Medicare) must cover so that the hospitals stay in business.  Even thought he Republicans will not admit it, this requirement that hospitals have a moral and legal obligation to treat the uninsured socialized the finances of the hospitals.  And that moral/legal obligation was codified by the 1980's GOP lead Congress and signed by Ronald Reagan.

So a rational debate about end of life care is essential if this runaway cost structure is to be efficiently contained.  And we have to pay for the government we want.  That means some rational debate about the government's finances.  And to have a rational debate, you need cordiality in Congress.  And today's partisanship politics in Congress precludes cordiality.

Link to Douthat column

Other parts of the health care that need to be debated are the rights of everyone to have access to every treatment.  Where are the limits on what the safety net will provide?  Most of the developed world has decided everyone will have access to the every treatment under the guise of a single payer health insurance system.  And any rationing is either done through queuing or the ability of the rich to  obtain treatments outside the system.  Here in the U.S., it is done through access to health insurance and if you cannot afford health insurance, you suffer until it is serious enough to put you in the hospital.

That is immoral and costly, which is why the Heritage Foundation designed RomneyCare/ObamaCare the way they did.  Given the hippocratic oath, health care has had a moral basis since the Greeks, and you would think every American would want a moral health care system as a goal.

The real problem is the Republicans have not been honest with their voters.  They still promulagate a supply side belief that lower taxes will allow us to grow into a no tax system.  But individual taxes are the largest source of government revenues and cannot go to zero.  We must pay for many things the government does and repay some of the debt that we borrowed by deficit spending going back 50 years under administrations of both parties and Congresses led by both parties.

This is the only thing Bernie Sanders have ever said that I agree completely with: