Health care or health insurance?

The political debate over guaranteeing health care or health insurance was put in sharp relief today by a story out of California.

The Los Angeles Timesbroke the story, of Wellpoint asking doctors to seek out pre-existing conditions in all new employees so coverage could be cancelled and costs cut.

WellPoint runs Blue Cross of California, the state's largest for-profit insurer. The Times' story includes a copy of one such letter, and in the story a spokeswoman for the company confirms the policy in an e-mail.

Doctors were outraged and the company quickly backed down in the face of the pressure.

Liberals are using the case to question the legitimacy of the health insurance system, noting that the companies cherry-pick risks rather than providing care.

Of course the industry is cherry-picking risks. They're selling insurance, not care. Insurance is not care. Insurance is if. Care means when.

Health care is an absolute need. Who pays for it is the question. Insurers rightly don't want to pay more than they absolutely must. Who pays for the rest, if employees are (as they are) dependent on insurance for care?

That's going to be the question as the health care issue evolves over the next few years. Care is an absolute. Ordinary people can't afford it. Yet somehow they get it. So who pays for it?

Conservatives are going to have to state, clearly, that the medical profession must reject its oath and refuse care, if they intend to win this debate. Either deny care or show how you pay for it. There is no third option.

The present system of fudge and pushing costs around just isn't working. It is in a state of slow, steady collapse. Already wealthy people find they can't get care even when they can afford it, from emergency rooms crammed with poor people.

It has yet to get through their thick skulls that you either tell the poor to die or you find a way to guarantee care.

But it's gotten through to the rest of us.