What should we do about health care? The current system is a mess, at least that’s something on which we can all agree. And the coming changes will either make things slightly worse or slightly better, depending on your political proclivities. But nobody’s claiming we’ve found the silver bullet — or silver scalpel, as it were.

What should we do about health care? The current system is a mess, at least that’s something on which we can all agree. And the coming changes will either make things slightly worse or slightly better, depending on your political proclivities. But nobody’s claiming we’ve found the silver bullet — or silver scalpel, as it were.


The problem is we want it both ways. We want a system that ensures no one gets turned away at the ER, but we don’t want anyone telling us what, if any, insurance we have to purchase to pay for said hospital visit.


Annoyingly, the issue has been colored by predictable partisan hyperbole. Here are Republicans in one corner yelling "Obamacare bad!" and there are Democrats in the opposite corner yelling — or maybe whispering these days, but still defending — "Obamacare will make things better!"


At this point, if the president declared pecan pie to be America’s pie, Republicans would write songs about how peach pie is superior, and Democrats would put pecan bumper stickers on their Priuses. We live in the age of perpetual partisanship.


But health-care reform shouldn’t be an issue that’s so starkly defined. It’s something that affects all of us, and something on which there’s broad-if-not-well-publicized agreement. Conservatives generally admit that every bleeding patient who shows up at the emergency room deserves immediate care, and no Liberal wants their doctor’s office to function like the DMV. So those are the surprisingly reasonable boundaries of the discussion.


But before we can talk about changing anything in particular, there’s a fundamental question we have to put to bed: it’s the question of income-based outcomes. Are we, as a society, OK with lower quality care for people who have less money?


Most people’s knee-jerk reaction to that question is, "No, your paycheck shouldn’t determine whether you survive an injury." But if that’s really how we feel about health care, then single-payer or socialized medicine is the only way to go. The only way to ensure money-blind outcomes is through rationing limited resources equally among all those who need them. As other countries have shown, there are advantages to a system like that (Cheap drugs!) and significant disadvantages (Moral hazard! Waiting lists!).


Back in my younger days, I used to watch "The Simpsons" religiously. Before there was "South Park," no television show handled political satire quite as well as Homer and the gang, and health care was no exception.


In the fictional town of Springfield, there were two doctors: Dr. Hibbert, he of high credentials and impeccable bedside manner, and Dr. Nick, who attained his questionable medical degree from Hollywood Upstairs Medical College. Those who could afford it went to Dr. Hibbert and received exemplary care; those who could not went to Dr. Nick for his "any operation for $99" special.


If we’re not willing to sacrifice our autonomy to a socialized system of medicine, we have to get used to the idea of Dr. Nick. Like it or not, resources — things like exceptionally talented doctors and MRI machines and hospital beds — are scarce, which means they either have to be sold to the highest bidder or distributed thinly; there is no third choice.


There are only "x" number of excellent doctors, while there are "y" number of patients. It’s hard to become a doctor, takes a good deal of time to become a great doctor, and practicing medicine is fraught with life-and-death decisions. In a quasi-market system, some people will have to suffer at the hands of inexperienced or less-skilled physicians. We can’t have Dr. Nick being sued out of business on a claim of malpractice every time one of his patients suffers complications.


Regardless of what sins Obamacare may or may not be guilty of, at the very least, it put the philosophical cart before the horse. Before we talk about what specific changes need to be made to the health-care system, we first have to decide which option is preferable: dying on a waiting list to see Dr. Hibbert, or taking our chances on Dr. Nick’s operating table.


We can be Sweden or we can be Springfield, but we can’t be both.


NATE STRAUCH is a reporter with the Herald Democrat. Email him at nstrauch@ heralddemocrat.com.