Barack Obama didn't break major news in his televised town hall for ABC News on Wednesday night. Instead, he used the occasion to hammer away at a key point--one that, I increasingly believe, holds the key to the entire reform debate.

On at least three separate occasions, Obama pointed out rising costs--left unchecked--are going to destroy the health care system. You might like your current insurance arrangements, Obama suggested, but there's no reason to think they'll be in place a few years from now.

At best, your plan will simply become less comprehensive and/or more expensive. At worst, it will no longer be available to you.

Or to put it more simply, change may be scary, but no change is even scarier.

The other noteworthy aspect of Wednesday's event, at least to me, was the focus of the questions. Some came from everyday Americans flown in for this occasion; others came from lobbyists and experts in attendance. But not until the very end, nearly 90 minutes into the show, did anybody ask a quesiton focusing on the uninsured, the uninsured, and--more generally--the problems that arise when people can't pay their medical bills.

Instead, there were a lot of questions about when--and how--to limit medical treatent, along with some questions about how to pay for reform. I have no idea to what extent hosts Charlie Gibson and Diane Sawyer picked the questions, but I can't help but wonder whether those questions reflect what's on their minds--as affluent people with relatively secure insurance--rather than what's on the country's.

(Anticipatory note to whomever is about to write a comment on my last sentence: I know that many, if not most, Americans are worried about whether they'll still have access to cutting-edge treatment. But many are also worried about how to pay their medical bils wihout risking financial ruin--many more, surely, than the tiny percentage that got a chance to speak last night.)

--Jonathan Cohn