Can a Politician Tell the Truth and Live?

Note: I disagree with the author's assertion that we can only have 2 of the 3 (see para 4 below), because on many fronts markets have shown us we can have it all if we can allow competition, and allow winning competitors to reap the benefits of their effort, risk taking, and success.

http://www.realclearpolitics.com/printpage/?url=http://www.realclearpolitics.com/articles/2009/09/14/the_candor_gap_98284.html
"When Obama says that "I am not the first president to take up this cause, but I am determined to be the last," he is indulging his ambition for a special place in history and illustrating why Americans don't discuss health care honestly."

"Americans generally want three things from their health care system. First, they think that everyone has a moral right to needed care; that suggests universal insurance. Second, they want choice; they want to select their doctors -- and want doctors to determine treatment. Finally, people want costs controlled; health care shouldn't consume all private compensation or taxes.
Appealing to these expectations, Obama told Americans what they want to hear. People with insurance won't be required to change plans or doctors; they'll enjoy more security because insurance companies won't be permitted to deny coverage based on "pre-existing conditions" or cancel policies when people get sick. All Americans will be required to have insurance, but those who can't afford it will get subsidies. "

"As for costs, not to worry. "Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan," Obama said. He pledged to "not sign a plan that adds one dime to our (budget) deficits -- either now or in the future." If you believe Obama, what's not to like? Universal insurance. Continued choice. Lower costs. "

"The problem is that you can't entirely believe Obama. If he were candid -- if we were candid -- we'd all acknowledge that the goals of our ideal health care system collide. Perhaps we can have any two, but not all three. "

"If we want universal insurance and unlimited patient and doctor choice, costs will continually spiral upward, because there will be no reason or no one to stop them. We have a variant of that today -- a cost-plus system, with widespread insurance and open-ended reimbursement. Higher costs push up premiums and taxes. That's one reason health spending has gone from 5 percent of gross domestic product in 1960 to 16 percent in 2007. (Other reasons: new technologies, rising incomes.) But controlling spending requires limits on patients and doctors."

"The candor gap reflects a common condescension. One side believes it must fool Americans into thinking "reform" will do more than it will; the other thinks it must frighten Americans into believing that it will harm them in ways that it won't. Given Americans' contradictory expectations, any health care proposal can be criticized for offending some popular goal. We refuse to face unavoidable -- and unpleasant -- choices."