One of the more difficult issues to explain, even for those of us who live and breathe health policy, is why expanding coverage and cost control go hand-in-hand. Among other things, past efforts at cutting health care spending haven't always worked as well.

Fortunately for all of us, Paul Krugman writes a biweekly column for the New York Times. He gets it. And today he does a great job of explaining it: 

Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers--but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.

Beyond that, I’d suggest that would-be health reformers won’t have the moral authority to confront our system’s inefficiency unless they’re also prepared to end its cruelty. If President Bush had tried to rein in Medicare spending, he would have been accused, with considerable justice, of cutting benefits so that he could give the wealthy even more tax cuts. President Obama, by contrast, can link Medicare reform with the goal of protecting less fortunate Americans and making the middle class more secure.

As a practical, political matter, then, controlling health care costs and expanding health care access aren’t opposing alternatives--you have to do both, or neither.

To be sure, making sure that cuts to health care spending are compassionate, rather than cruel, involves more than just providing insurance for everybody. It also involves making sure insurance covers what people need, both in terms of financial protection and medical services. But Obama and his supporters want to do that, too--and their plans reflect that. More on that soon.

--Jonathan Cohn