Robert Samuelson, a kind of Captain Bringdown of economics columnists, argues that we cannot have an honest debate about health care so long as it is about expanding coverage. He writes:

>The politics of health care rests on a mass illusion:

I know what you’re thinking. The illusion is that way too much of the money Americans spend on “health care” pays for needless bureaucracy, so that’s what we need to cut, right?

Nope.

He continues:

>Most Americans think that someone else pays for their care. Workers with employer-provided insurance believe that their companies pay. Retirees and the poor think that the government, through Medicare (retirees) and Medicaid (the poor), pays. No one has an interest in controlling spending, because everyone believes that it burdens someone else. Naturally, the health-industrial complex — doctors, hospitals, drug companies — has no interest. Higher health spending raises their incomes and profits.

The problem is that people need health coverage. Perhaps they should need it less.

In all seriousness, while serious discussions of cost are always appropriate (I could make a living making that argument: here’s the formula: none of the candidates seriously want to address issue x, which is serious because of y, therefore z), Samuelson has to be aware of the rather obvious and well documented problem of how health insurance bureaucracy consumes a giant share of health care spending. Can’t we cut that first?