"We need to have a candid debate about health care in 2008, but the odds are against it," as presidential candidates have focused on the issue of the uninsured, rather than "runaway health spending" because "expanding benefits is so much more politically rewarding than trying to control them," Washington Post columnist Robert Samuelson writes. Health care spending, which totals more than $2 trillion annually, accounts for 16% of gross domestic product and could account for more than 25% of GDP by 2030, Samuelson writes.

According to Samuelson, the "unchecked rise in health spending" likely will "increase taxes, depress take-home pay and crowd out other government spending," but "our national policy toward these issues is: Don't ask, don't tell." The "politics of health care rests on a mass illusion," as most U.S. residents "think that someone else pays for their care," he writes, adding, "No one has an interest in controlling spending because everyone believes that it burdens someone else." Samuelson writes that U.S. residents "need to see and feel health costs."

Samuelson recommends an increase in contributions from Medicare beneficiaries, the establishment of a "dedicated federal health tax" that covers all health care spending by the federal government and increases as costs increase, and the replacement of the "income tax exclusion for employer-paid insurance" with a "tax credit of lesser value." The proposals would allow for a debate on "how big the government's role should be" in health care, he writes, adding, "Don't hold your breath" because these "would inflict 'pain,' and candidates who embrace them would invite political ruin."

Samuelson writes, "Health care is ultimately a political issue of making choices," but the "present politics aims to camouflage the costs and skew the choices," adding, "Until we change that, our debate will lead to dead ends" (Samuelson, Washington Post, 12/6).

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