By Norm Bell

Every few years, it seems, we as a nation come to a fork in the road where we need to make a society-altering choice.

Health care reform is such an issue. And no matter where you stand on the political philosophy, it’s clear that the debate could proceed in a more productive – and, yes, civil – manner if the facts weren’t quite so slippery.

When politicians start talking about committing hundreds of billions or even trillions of taxpayer dollars, common sense argues for paying attention. Few of us have any idea of the value of a billion, much less a trillion. They lost us several zeroes ago.

But most of us do have a feel for the nature of the play money that fuels the health care debate. Look no farther than your last medical bill.

A few weeks ago, I went to my doctor in Aventura and he ordered a set of routine blood tests. Thankfully, the results weren’t alarming. But the bill was.

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The laboratory services provider had billed my insurance company almost $500; the insurer paid almost $60: I paid nothing out-of-pocket.

The doctor did a little better. Between the insurance company and my co-pay, he actually collected about half of what he billed, far better than the 12 percent the lab test firm received.

On prescription drugs, it’s the same song, just a different verse.

Every three months, I get a prescription refilled by my insurer’s mail-order pharmacy. Delivery of the drug is followed by a statement trumpeting that my insurer has saved me 75 percent off the $160 cost of the drug.

That was much more persuasive before a local pharmacy started advertising the same drug, same strength, same number of pills for $14.99.

Obviously these numbers are just a microcosm of what’s happening every day in America’s health care system.

With numbers like that, it’s not hard to see where reformers claim they can save billions without adversely effecting care.

One argument is that the billing is artificially high to offset the cost of uninsured, indigent care. The insurers nod, pay the negotiated rate and the balance slips away into some fantasy land. The rubber only meets the road when medical providers run out of ways to make ends meet and close or when middle-class wage earners lose their insurance and actually have to try to pay the inflated bill.

A good place to start the discussion is by defining real costs. If we can just agree on what’s an acceptable price, we can start talking in dollars and cents instead of in circles.

And that would make evaluating the whole health care reform debate just a little easier to understand, discuss and ultimately agree on a course of action.

After all, it’s our future. We’d all like to get this right.

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Norm Bell is an Aventura resident and editor of talkofaventura.com Reach him at nbell@talkofaventura.com