One of the things that's striking about a lot of conservative opposition to health care reform is it's almost complete obliviousness (or at least feigned obliviousness) to the crushing unsustainability of our current system. So there's lots of scary talk about rationing by government bureaucrats, but no nod at all to the basic laws of arithmetic (or, at least, budget charts) that will sooner or later force some serious rationing of their own. (Nor, for that matter, is there any acknowledgement that health care is already rationed by price, but you've heard that one before...)

Today's Washington Post op-ed by Republican economics guru Martin Feldstein is a classic of the genre. Feldstein writes:

But the administration's goal is bigger than that. It is to cut dramatically the amount of health care that we all consume.

A recent report by the White House Council of Economic Advisers claims that the government can cut the projected level of health spending by 15 percent over the next decade and by 30 percent over the next 20 years. Although the reduced spending would result from fewer services rather than lower payments to providers, we are told that this can be done without lowering the quality of care or diminishing our health. I don't believe it. ...

The administration's health planners believe that the new "cost effectiveness research" will allow officials to eliminate wasteful spending by defining the "appropriate" care that will be paid for by the government and by private insurance. Such a constrained, one-size-fits-all form of medicine may be necessary in some European health programs in which the government pays all the bills. But Americans have shown that we prefer to retain a diversity of options and the ability to choose among doctors, hospitals and standards of care.

At a time when medical science offers the hope of major improvements in the treatment of a wide range of dread diseases, should Washington be limiting the available care and, in the process, discouraging medical researchers from developing new procedures and products? Although health care is much more expensive than it was 30 years ago, who today would settle for the health care of the 1970s?

Sounds great. I like choice and diversity. I hate the '70s. Sign me up. Oh, except: HOW ON EARTH DO WE PAY FOR ALL THAT?

You'd think conservatives, so quick to moan about the unsustainability of wasteful spending in other contexts (namely government), could appreciate the unsustainability of health care spending, too. (Particularly since the same forces that drive private-sector health-care inflation also drive government spending on health care--though I guess the magical solution there is less government spending and still more private-sector spending.) Alas, such an appreciation is nowhere to be found in their scribblings on this subject.

--Noam Scheiber