Health care reform seems hopelessly complex only because it is. Yet, there are a few underlying, but seldom spoken about, forces that make it more intelligible. All of this is in accord with a fundamental principle of political economy; important issues that are complex and carry heavy emotional baggage naturally generate error and acrimony. Political deception naturally follows.

Here are a few guidelines for understanding this mess. First, please don’t assume that those who advocate positions counter to yours are wicked. A few no doubt are, but most are merely confused by the complexity inherent to this contentious issue.

Second, recognize that ameliorating illness and infirmity for one’s self and those one loves ranks extremely high among the many values one seeks. As technology advances, health care professionals can do ever more. But this really is expensive. And while the costs of some procedures drop over time and with experience, in general costs will increase.

As the developed world becomes wealthier, people naturally demand better health care. Hence, an ever-higher proportion of GNP goes to health care. And, of course, the rich and well connected will obtain better care. When Fidel Castro suffered a botched operation, he had a chartered jet fly in a Spanish surgeon with advanced O.R. equipment. Such preferential treatment occurs across time and cultures. No system will change this elemental fact of life.

Third, we are witnessing a fundamental debate about the role of government in society. Those with an unconstrained vision of the good that government can do see health care reform as an opportunity to increase government’s scope and power. And they are surely correct in believing that once health entitlements are given, they are exceedingly unlikely to be voluntarily removed. Government provision of a valued service works as a non-reversing ratchet.

In contrast to those above, some people recognize that personal health care decisions, like all others, are made on the basis of information and incentives. They focus on flawed institutional arrangements. This includes third party payments that insulate demands for service from the costs of those services. When anonymous others pay for exams and care, patience is the limit for patients seeking care.

Related to this is behavior leading to disease and infirmity. Should taxpayers be responsible for health problems generated by harmful lifestyles? Perhaps two-thirds of expensive health problems result from smoking, obesity, and lack of exercise. If government pays for resultant problems, shouldn’t it have substantial influence over the causes? The implications are indeed messy—and troubling to those concerned with individual autonomy.

Fourth, government by its nature implies bureaucracy. And bureaucracy is incompatible with compassion. Here is a case illustrating the problem.

A warrior wounded in Iraq was released from his military hospital for a Thanksgiving visit to Idaho with family and friends. His passion was hunting and fishing. Idaho had a program that offered disabled military personnel a deep discount on hunting and fishing licenses. The warrior had lost his right arm above the elbow and left leg above the knee.

Friends offered to take him hunting and he went to his Nampa, Idaho DNR office for a license. He showed his military ID and requested the special license. The woman said that Idaho was proud of this benefit for injured veterans and asked for his certification of disability.

He explained that he didn’t have it for he was still in the Army, out on hospital release. “I’m sorry,” she said, “Without the proper card I can’t give you the special license.” “But ok,” he replied, placing his stump of an arm on the counter and pointing to his leg prosthesis, “I don’t have an arm and a leg but I do have my military ID.” “I’m sorry,” she responded. He paid the full fee, and went hunting with his friends.

I offer this lesson in bureaucratic pathology as a cautionary tale for all seeking health care reform.