Is it possible?

I would like to pose a question to all of you:

Can we actually afford a health care system that provides comprehensive, high-quality coverage for everyone?

I ask simply because the entire health care reform debate seems to operate on the assumption that we can but that we just haven't figured out the secret yet. Somewhere, we believe, lurks a solution -- tweak this, restructure that and...voila! Some combination of strategies must work...right?

But is that really true? No matter what kind of cost, quality, and infrastructure improvements we make -- and to be sure there are many -- the leaner, meaner system we end up with will still be massively expensive. Do we have an idea of how much a perfectly built and operated system would cost? Really, how much is it? Does anyone know? Can we afford that cost?

If we cannot afford it, how does that change the parameters of the debate and the shape of the resulting reform? Will we need to change what we expect from our health care? Will we have to revisit the dichotomy of health care as a right vs. health care as a privilege?

Unless we set reachable goals, this reform process will be meaningless and the search for solutions will be fruitless. So, I ask all of you, Is effective, high-quality care for all a reachable goal?

I sure hope it is. I hope that improving quality, cutting out waste, making care more efficient, and emphasizing prevention instead of reactive treatment will make it all possible. I'm betting my career on it!

What do you think?

-- Alexi