Most of us aren't facing up to the real problem of health care.

[pnwmom]

The high costs of the high tech medicine that we'd all like to make universally available and affordable. The high tech medicine that is helping to extend most of our lives, and keeping those of us with chronic conditions in more active lives.

We laughed at Sharon Angle when she talked about paying for doctors visits with chickens. But I think a lot of people feel the way she does; they just don't express it the same way.

We're way beyond the days when doctors made visits with their black bags, set broken bones, and dispensed mostly pain relievers. More and more, medicine is about mammograms, colonoscopies, sonograms, MRI's, radiation treatments, etc. All of this requires expensive equipment with expensive upkeep and training. And doctors, who have had far more lengthy and intensive training than in our grandparents' and older generations, expect and deserve good compensation for their effort. And staffing hospitals with an adequate number of qualified R.N.'s is expensive. And even preventative medicine -- all those mammograms and colonoscopies -- can be costly. But some of us still expect health care to be the same fraction of income that it was back in the horse-and-buggy days.

So the question of rationing has to come to the forefront, eventually. If not based on ability to pay -- which clearly isn't fair -- how do we decide who gets what? How do we decide enough is enough? For example, the majority of a person's lifetime medical costs are often spent in the last few months of life. But, for most people, we don't know ahead of time which will be the last illness, so we don't know ahead of time which costs might be not be worth it. I have a relative who had cancer surgery at the age of 86, and had chemo for a different cancer. Ten years later, she's still living independently. To those who love her, the many thousands spent on her by Medicare was well worth it. But if, as a society, we were rationing, would we spend that much to extend the life of an 86 year old with two kinds of cancer?

What about a baby born 10 weeks prematurely? What about a person who'd been in a coma for weeks? Should those decisions be made only by families -- or , with universal health care, does society have an economic interest in getting involved in those decisions?

How would we choose? What would we choose? Who would decide? I think too many of us think that Medicare for all would solve all our problems. It won't. It will just open up a new, very uncomfortable set of problems. Problems almost too painful to think about.