The recent Federal District Court holding that Obamacare is unconstitutional is another distraction to the real problem, which is, in case it has been drowned out by all of the static, how to improve health care for Americans in the context of the current economic situation.

I do not see how the issues of health care and health care reform can be solved without a shared view of our priorities.

What is the correct balance between entitlement programs directed to the elderly, disabled, and poor Americans, including the newly poor, unemployed, and uninsured, on the one hand, and a crippling federal debt, fighting wars to protect our security, and increasingly economically strapped individuals, businesses, cities, and states, on the other.  Is access to health care a right?  Is it more important than education, security, or economic and social freedom?

All these things are important to us as Americans.

So, what do we do first?  In my opinion, we must do two seemingly incompatible things simultaneously — improve the quality of the care given (that includes allowing more creative and alternative modalities and providing more preventive care free of insurmountable regulatory obstacles) and reduce the overall costs of the care (that includes eliminating unnecessary, defensive, and fraudulent care).

We cannot talk about how much we should spend on health care without knowing how much it actually costs.

Obamacare is sensitive to these issues, but, at the same time, it is insensitive to the regulatory and economic burdens it places on Americans.

How do we talk about priorities in health care?  We start with answering the question of “What would an ideal designed-from-the-ground-up health care delivery system look like?”  If we don’t even try to understand what the ideal is, how can we know how to rank our priorities?  In the endless process of legislating and adopting regulations, and incessant political bickering, has anyone taken the time to think about the question of how should health care delivery work in America?  That would be a good place for a bipartisan effort.

This is not hopeless.  Americans are finding ways to address our health care crisis on their own.  Read the article, “The Hot Spotters,” by Dr. Atul Gawande in the January 24th issue of The New Yorker.  President Obama is correct when he says “Yes, we can!”  He is also correct when he said in his remarks on the State of the Union last month that “We do big things” in America.

It’s time.

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