A trillion here, a billion there, and pretty soon we’re talking real money. The House of Representatives has now passed its version of health care reform—a gargantuan 2,000-page, 70-pound collection of mandates, regulations, and subsidies that may well be among the most expensive pieces of legislation in U.S. history.

As a physician who practices extensively within the Medicare system, I can speak about the role government plays in American health care. As a result of my experience, I support continued government involvement in supplying health care to the needy of our country, and I also agree with the current administration’s emphasis on extending health insurance coverage to all Americans.

According to the clichés of political discourse, the Obama administration is trying to “move the country forward” by, for example, overhauling the health care system. The president’s agenda includes a “public option” for health insurance, the purpose of which is to “keep the industry honest” and hold down costs. Is that idea as progressive as progressives believe? Perhaps not.

Ronald Reagan famously said, “The government’s view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it.“ If he were watching Washington today, Reagan might add, “Once government subsidizes it to near death, nationalize it.“

The Times-Dispatch will hold a Public Square on health care reform tomorrow at 10 a.m. in our downtown office at 300 East Franklin St. Two of the Richmond area’s congressmen—Republican Eric Cantor and Democrat Bobby Scott—will discuss their views and take questions from the audience. It is an opportunity to gain deeper knowledge about one of the most complicated issues facing the country.

Health care reform has two goals: to control our gargantuan health care costs and to enable people, especially sick ones, to buy health insurance at an affordable price. The two goals are related—the better we control health care costs, the more people can afford to buy health insurance. Unfortunately, hardly anybody believes in the promise of congressional reform packages to control costs by creating a new public health insurance plan and Uncle Sam’s Monopoly Health Insurance supermarket (obscurely called an “exchange”). The ostensible rationale for both is that the federal government’s superb managerial skills will force down the costs of insurance and its distribution; but the American people do not believe it.

As President Barack Obama prepares to address Congress on health care reform, America’s pro-life movement is gassing up. If Obama hasn’t liked the tenor of town-hall meetings, wait until he meets pro-lifers at full throttle. They’re in the midst of a major drive (to exhaust the metaphor) to try to stop federal funding of abortion as allowed under proposed health care legislation.

This will be a long ride, so hold on. In a post on dickmorris.com, Dick Morris and Eileen McGann write: “As if Obama’s health care proposals were not flawed enough, CBS News reports a previously unnoticed provision of the bill which makes a shambles of any privacy surrounding your federal tax returns. Under the House bill, the IRS is required to make available to the new government Health Choices Commissioner established by the legislation and to each state health program all of your personal tax information.

When exactly did the Republicans start operating one of those marketing scams that target the elderly? It was bad enough when Sarah Palin told a bald Facebook lie that there were “death panels” in the plans to reform health care. It was worse to see Iowa Sen. Charles Grassley flunk the “pants on fire” test as he seconded this myth. Republicans planted the fear that President Obama wants to “kill Granny.“ Now they want Granny to kill health care reform.

I’m a big believer in skepticism. I don’t take things at face value. I know, for example, that 2+2=4. People who do math for a living tell me this is true, and I’ve seen it with my own eyes. So, if someone with shaky credentials shows up one afternoon and tells me that 2+2 really equals 6, I’m going to take it for what it’s worth, which isn’t much.

In the 48 hours of June 15-16, President Obama lost the health care debate. First, a letter from the Congressional Budget Office to Sen. Edward Kennedy reported that his health committee’s reform bill would add $1 trillion in debt over the next decade. Then the CBO reported that the other Senate bill, being written by the Finance Committee, would add $1.6 trillion. The central contradiction of Obamacare was fatally exposed: From his first address to Congress, Obama insisted on the dire need for restructuring the health care system because out-of-control costs were bankrupting the Treasury and wrecking the U.S. economy—yet the Democrats’ plans would make the problem worse.

With so much bad legislation snaking through Washington these days, it’s tough to keep track of it all. It’s almost as if the president and the Democratic Congress want to pass bills before anyone else knows what’s knows what’s in them. Aided by a supine press corps, this tactic worked for the stimulus package, and it allowed the House to pass—by a polar bear’s whisker—cap-and-tax legislation.

My husband’s mother will be 90 in October. She grew up on a Wisconsin farm less than 50 years after the Ingalls family lived in their little house in the big Wisconsin woods. Industrious, hard-working, and always cheerful, she personifies the Midwestern work ethic. Hers has been a life dedicated to family, church, and career. Now that she is older, she has slowed down a bit. She no longer volunteers with the health department, but she still lends a hand at the local hospital and a nearby senior center.

So-called end-of-life issues have generated great controversy in the debate regarding health care. Sarah Palin says the legislation sets up death panels. Others assert that while the bill does not mandate end-of-life discussions with doctors and other professionals, patients will feel pressured to hold such talks. Still others consider the language absolutely benign. Last week Charles Grassley (R-Iowa) said the Senate Finance Committee will drop the end-of-life sections, which remain in the House bill. We have been ploughing through the America’s Affordable Health Choices Act of 2009 (HR 3200). Here is the relevant section, “Advanced Care Planning Consultation,“ which amends Section 1861 of the Social Security Act:

No single topic drives the health care reform debate like the number of uninsured Americans, variously numbered in speeches and ads at 45 million, 46 million, 47 million, or even 50 million. Unfortunately, most of what we think we know about the un insured is wrong. For the record, according to the latest figures from the Census Bureau, 45.6 million Americans currently lack health insurance. This is actually down slightly from the 47 million that were uninsured in 2006. However, those numbers don’t tell the whole story.