The next phase in the coordinated campaign of anti-reform rhetoric in the health care debate apparently is to dip back into the Bush 2004 playbook and trot out the Red Herrings. I draw your attention to a recent editorial entitled "Fix the costs first." To wit:

The need for health reform is as plain as the headline on the front page of Tuesday's editions of The Buffalo News: "Salaried employees suffer loss of health care, reduced pensions due to Delphi bankruptcy." The system is falling apart. The wailing from the political right notwithstanding, without reform, we will have rationing.

But those on the left who continue to deny that controlling costs must be the first order of business need to read the same story. Today it's Delphi Corp. in Lockport, a company that is under severe economic strain. But as the costs of health care continue to soar — reaching 20 percent of gross domestic product by 2017 — more companies will find themselves under severe economic strain. Employer-based health care will become increasingly less available.

It's only a matter of time until we are besieged with warnings about capping malpractice claims.

Costs are not causing the problem, they are the end result of it. Drawing upon my experience in the world of medical collections – briefly, lest I start having flashbacks – the average hospital writes off tens of millions of dollars in services annually. That is to say lots of people are receiving services for which they don't pay. We know that emergency rooms are required by Federal law to treat any patient who presents himself regardless of ability to pay. For people without health insurance and with meager incomes, this becomes the sole source of medical care. Hospitals attempt to compensate for services they essentially provide for free by breaking it off in the ass of every patient with half-decent insurance. So the next guy through the door with a Blue Cross PPO gets charged $75 for an ibuprofen in an effort to make up the difference. Hospitals then pay insurers a discounted bulk rate for claims – thousands at a time – according an arcane formula that ends up being slightly more complicated than a group of astronauts doing their taxes in Latin. In short, they charge you $75 to get a negotiated payment of $60 from your insurance to start compensating for the fact that they just did a $15,000 operation to pull the steering column of a 1994 Toyota Tercel out of the sternum of an uninsured teenager.

The costs can't be controlled prior to extending coverage to everyone. The presence of 50 million uninsured people is in fact contributing mightily to the disconnect between the costs of medical care and reality. Bask in the rich irony as the Glenn Beck fan in the next cubicle wails loudly about how he isn't going to pay for anyone else's health insurance. We already pay for the uninsured. It's just a big, disorganized trainwreck, clearly superior to a government-administered program which would achieve the exact same end result.