Health care policy guru Ezra Klein has an op-ed in today's LA Times taking on the notion that reforming health care would lead to a "rationing" of care. We've all heard the horror stories about Canadians and Britons waiting for months to receive elective surgery or hours to see a doctor. Thank goodness we do things better here in the US, right? Not really:

Britain and Canada control costs in a very specific fashion: The government sets a budget for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more. One of the ways the British and Canadians save money is to punt elective surgeries to a lower priority level. A 2001 survey by the policy journal "Health Affairs" found that 38% of Britons and 27% of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5%. Score one of us!

Well, sort of. American healthcare controls costs in another way. Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves. So although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of those who can't afford care simply won't get it.

What people don't often talk about, Klein points out, are the several other countries - like France, Germany, and Japan - who have figured out that the real solution to health care lies somewhere between the extremes of the United States and the United Kingdom.

Regardless of what the plan for reform looks like after it's moved through Congress, one thing is certain: the worst option we have for health care is keeping things the way they are.