Timothy Johnson’s opinion piece in USA Today is just that – opinion, and a markedly biased one at that. Though the health care ‘right vs. privilege’ argument is old, it is not the question America faces today. Both the argument and Dr. Johnson’s solution of universal health care are vast oversimplifications within the larger health care landscape that we all agree needs reform.

Yes, American health care is more expensive than anywhere else in the world. I believe that this results from a culture of ‘premium’ medicine, as detailed by Dr. Arnold Kling in his book “Crisis of Abundance.” Dr. Kling is an MIT economist who previously worked on the Federal Reserve Board.

Premium medicine includes the regular and widespread use of: screening for preventable diseases, advanced technology like magnetic resonance imaging (MRI) and computerized tomography (CT), and heroic late-stage treatment measures. American patients expect these treatments and doctors certainly want to provide them. We have an abundance of medical specialists and technology that we want to use, and while everyone would like a basic level of universal health care, they also want unlimited access for themselves.

The question is: can we have our cake and eat it, too? Our present patchwork health care system tries to do this via personal, employer-based, and government health insurance. However, since a third-party payer insulates us from the true cost of medicine, and everyone expects premium care, spending has risen. This isn’t a ‘moral hazard,’ it’s just what happened. Logically, by increasing the amount of third-party payment, you would expect greater spending.

Do the universal health care models of Europe provide the premium medicine that Americans very reasonably want and expect? No. Universal health care has shown itself repeatedly to require rationing in order to stay afloat. There are long waits for treatment and limited access to advanced care. England just came out with an assessment of their National Health Service (NHS) and found that neither the quality nor efficiency of their hospitals is what they’d hoped – only 4% received marks for excellent quality and a full third were weak on efficient use of resources. Canadians may have cheaper medications secondary to price controls, but they often pay more for generics and freely benefit from American dollars spent on the research and development of new drugs.

In fact, America’s approach to health care may not be as misguided as we all think. Our spending in medical research and development has led to 34 Nobel prizes in medicine since 1980 – 60% of the total awarded. It has led to 4 of the 6 most important medical advances of the past 25 years: MRI and CT, ACE inhibitors (that lower blood pressure), statins (that lower cholesterol), and coronary artery bypass. Dr. Tyler Cowan, a Harvard-trained economics professor at George Mason University, recently published a very eloquent article this topic.

Every time we learn something new, that information gets shared, and life expectancy increases throughout the developed world. Yet we compare ourselves to countries like Sweden that are 1/33 our size and feel inadequate when we come up short on infant mortality. At some level this is simply a numbers game. We have 300 million people and a level of immigration unparalleled in the world. A direct comparison of the U.S. to European countries or even Canada is not informative. It’s the proverbial apples and oranges.

We are improving, however. If ever so slowly, I believe we are moving toward a system where basic health care will be accessible to all, while retaining the option for individuals to access unlimited care – a modified version of the mixed public and private health care system we have now. Government programs already subsidize large portions of American health care (specifically the poor, disabled, and elderly) and these programs will no doubt continue. Federally Qualified Health Centers continue to expand, in order to ensure that access to affordable care is not a limiting factor. Nonetheless, it is market-based health care that is and will be essential to maintaining the world-class ‘premium’ medicine that people travel across the globe in search of.

Health information technology (HIT) is already a part of this plan. The House recently passed legislation promoting HIT and electronic medical records, while the President’s 2007 budget requested $64 billion for just that purpose. President Bush has also issued an executive order calling for price transparency within the federal health care system, an issue that I have introduced legislation on in the private sector, in the hopes that prices will come down and quality will go up as American know what they are paying for.

Universal health care won’t let us have our cake and eat it, too, but American ingenuity just might find a way to make it happen.