Health care reform is no longer just a moral imperative, it's a fiscal imperative.
President Barack Obama

He is right, of course. The health care debate has shifted beneath our feet.

Why? The Party is Over.

One day, we will look back wistfully on this moment and recall our privileged status regarding health care in America. How good was it? Almost anyone with a job, or was married to someone with a job, or lived with parents with a job, enjoyed nearly unlimited access to a truly miraculous system of health care. Although we have NOT spent a lot of time appreciating the wonder of the current system, the vast majority of us have been privy to the best-trained physicians, the most advanced medical technologies, and the most comprehensive network of doctors and facilities ever assembled in the annals of medical history.

Those days are necessarily coming to a close.

Why? Not merely because the "Radicals have taken over." True, Barack Obama and his brain trust seem intent on finally fulfilling the ancient New Deal promise of national health care, which has always portended a leveling effect on the quality of care--but that fact is merely incidental to this story. This inevitable change is not driven primarily by the "social justice" side of the political ledger--or, as the President characterizes it, "the moral imperative."

For decades, we have been very close to totally deaf to the sad refrain of "forty million uninsured" fellow citizens. Why so unresponsive? Partly because the claim is something of a distorted and transparent political manipulation, but mainly because the vast majority of us were thriving under the status quo. We are not a blindly utilitarian society, but when the great bulk of the citizenry are prospering under a given regime, they are loath to sacrifice their advantage for a disadvantaged minority. In that regard, nothing has changed. Collective compassion will not be the impetus for the massive change in the offing.

What then? Unsustainable costs necessitate our coming transformation. Ironically, we are victims of our own success. The wonders of medical research and development and production have outdistanced our financial resources. Most of us do NOT assume we are inherently deserving of the very best and most-advanced products in our consumer culture. We make choices commensurate with our ability to pay. Most of us do NOT feel entitled to drive top-of-the-line automobiles regardless of our ability to afford one. Most of us understand that we must settle for the computer, television, or stereo that fits within our budget.

But not in regard to health care. If we are sick, by God, we figure we ought to have access to as many PET scans, CAT scans, and MRIs as we can fit into an afternoon visit to the Medical Plaza. That sounds fine, doctor, but let's bring in the specialist for a consultation. Private Room or Semi-Private? Do you even have to ask?

Conservatives bristle when Liberals enumerate health care as one of the recently found bedrock undeniable human rights. In the abstract, if we are compassionate conservatives, we prefer to characterize universal access to medical care as a positive good that falls within the scope of community interest--but not an inalienable right endowed by the Creator. We delude ourselves. We should acknowledge the acute sense of entitlement among the American middle class (regardless of party or ideology) concerning medical care. While we robustly debate the level of care society owes the "poor folks," we have no doubts that we deserve the platinum treatment. We work hard; therefore, we warrant the very best medical care available.

Part of our disconnect rests in our sense that health care appears free to us. Of course, rationally, we understand perfectly well that nothing in this life is free. As Milton Friedman loved to remind us, "there is no free lunch." Somebody always picks up the bill. For most of us, as intimated above, it is our employers--and then gets passed back on to us indirectly and discretely. But the truth is, and here is the rub, the rising costs are fast-approaching a prohibitively burdensome strata. How much longer can companies continue to shoulder this cost of living as part of our compensation packages? Not forever.

But this also begins to obscure a more important point. It is not just that our employers can no longer afford our health care, because, as we say, the money for health insurance comes in the form of compensation and is part of the overall cost of doing business and is passed back into society and absorbed by all us indirectly. Conceivably, we are getting paid less (and, hopefully, taxed less) because our employers are compensating us with benefits rather than salary. In itself, shifting the burden from the private sector to a one-payer system (national health care) will do nothing to solve the problem.

To repeat, the fundamental problem rests in the UNSUSTAINABLE rising costs. As a society, we CANNOT afford to pay for health care through government agency anymore than we can afford our current system of health care as an employee benefit.

The obvious solution is cost control, which means rationing care, which means the Golden Age of carte blanche health care is concluding.

How we get there remains undetermined, but the ultimate destination is certain.

The Party is Over, and the time has arrived to pay the piper. We are not going to like it, but we better get ready for it nevertheless.