Mickey Kaus writes that “we shouldn’t reform health care in order to reduce costs, and that we shouldn’t expect health care reform to in itself control the health care entitlement problem that’s scheduled to devour the budget.”

In fact, it is going to get a whole lot more expensive ($645B proposed by the Obama team is just the “downpayment”) if some of the plans rattling around Congress are enacted. The notion that we can cover more people, offer a “public option” (which then squeezes out private insurers and limits competition) and, presto, wind up with cheaper care is a fantasy. You can “invest” billions for some government-run system of electronic records, but you aren’t going to recoup a fraction of the cost. This is why nearly every country that has tried a nationalized healthcare scheme must in the end ration care — or wind up breaking the bank.

None of this is to say that expanded coverage is not a worthy goal. It does require that we face up to the fact that if we pursue a public option/nationalized model we will place a very substantial burden on the taxpayers. So rather than pretending this is a cost-saver — which allows us to indulge in even more carefree spending on other domestic programs — we should instead recognize the need to explore options which really do reduce cost such, as those suggested by John McCain during the campaign (e.g. interstate insurance competition, tax credits to make individuals responsible for their health insurance purchasing).

And in the end, we must acknowledge that richer, more advanced countries pay more for healthcare and the ever-expanding cost of new treatments (which leads to more medical care for the elderly). That is not a bad thing, but it does require we make some informed choices about our domestic spending.