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I was listening to the radio the other day and it occurred to me that there may be some problems with the American health care system. Just about every politician is talking about it and about as much as we can grok from all the rhetoric is whose plan isn’t going to work. But it seems to me that we’re getting ahead of ourselves.

When you’ve been around more than a few IT projects (or any sort of project I reckon) you start to develop a sense about what works and what doesn’t. The longer you’re in the business, the earlier you can spot pitfalls. The pitfall that’s going to torpedo our health care debate is failure to understand the problem at hand. Without understanding and agreement about exactly how our system is failing, there’s just no possible way we can fix it in any reasonable matter.

Part of the reason for this is situational. While it’s easy to lump all Washington politicians together, there are some pretty important philosophical distinctions at work. Differences in core economic and social thinking prevent lawmakers from finding a suitable mutual starting point. The first step to a cure is admitting there’s a problem, and we’ve beat that one to death. We know it’s broken, we know it has to be fixed, but let’s define what we want before we define how we’re going to get it.

So what do we want? Is health care too expensive? Too unavailable? Are not enough Americans covered? How many should be covered? Are we entitled to have routine checkups paid for out of public coffers? Are poor people entitled to the same care as rich people? Do we have a right to free health care? If not, should it be tax deductible? Why should Joe get a great PPO for he and his family while Fred gets an entry-level HMO for himself and the option to pay out of pocket for coverage for his wife and two children? Should gay couples in committed relationships have family coverage made available to them just like heterosexual couples? How about hetero life partners or cohabitant unmarried parents?

We can’t even begin to work on a solution until these questions are well on their way to being answered. And here is where the compromise will have to come in. There’s a damn good chance that we’ll screw the whole thing up again just trying to arrive in the middle. But we need to define the problem first.

I generally consider myself a Libertarian so I’d love nothing more than to see the free market at work here. The health care industry is far too regulated to say that we’ve given this an honest try. We’ve protected big pharma from cross-border competition to the detriment of just about everyone, and the FDA prevents common, safe drugs from being dispensed without a costly doctor visit in which the patient may or may not even see an MD.

But the Liberal in me tends to think that in this day and age there ought to be some way of taking care of the citizenry to the extent that a doctor visit is neither a complete hassle or a huge expense. But the Liberal in me isn’t Liberal enough to admit that every American has the right to free health care, no questions asked. Sure we have the unalienable right to life, liberty and the pursuit of happiness, but when did the land of opportunity become the land of guarantees or the land of handouts? At what point does entitlement for the truly needy turn into redistribution of wealth on an unfair scale? Is redistribution of wealth fair because those who cannot should be entitled to the fruits of those who can? At what point does this become Communism?

But I digress. I’d love to hear some opinions on this so comment away!