The missing piece of health care reform is ...

Prices.

No change in policy will improve health care nearly as much as reintroducing prices for valuation of treatment.

Most people:

A) have severely limited or no real choice about their health insurance. In the majority of cases they either take what their employer gives them, or get to choose from between two or three levels of coverage from the same company. And the insurance companies face state walls, meaning that I as a Kentuckian can't buy coverage from say,

B) Have a dim grasp, if at all, of how much insurance costs. I'd be willing to wager that most people would have to study their paycheck stub to tell you what they pay for health insurance (unless, of course, they pay nothing), much less the size of the company's (almost always) larger share (about 4/5).

C) Have a dim grasp, if at all, of how much medical treatment costs. Because they have insurance, either publicly (more than a quarter of the population are insured through government programs, not to mention the millions whose employer is the government) or privately, are rarely ask to directly pay for procedures.

No one can really tell you what the market value of any medical treatment is because of these, and other, market distortions. What history shows, again and again across any range of circumstances, is the introduction of prices to indicate value drives down costs and drives up quality.

Some would say we should all have the same coverage, with "health care equality" being a buzzword. But we readily accept less than equality in other areas just as important. In fact, we welcome it.

Everytime I want to buy an apple, I have to decide where I want to buy it, because I have choices. It's probably cheapest at Wal-Mart and best from the Farmer's Market, but somewhere in between at Whole Foods. But Wal-Mart's fartrher than I want to go, and the Farmer's Market is somewhere different everyday. So I way the price, quality and time required for obtaining an apple, or any other food, in making that choice.

If you're looking for a place to live, the classifieds offer a nearly indecipherable abbreviated language that indicates where an apartment is, how big it is, how many bedrooms and bathrooms, upstairs or down. And, of course, the rent, which balanced against those other specifications helps you make a decision.

If anything, buying a shirt offers an even greater variety of options. Size, color, style, fabric, quality, brand. And price. How will we ever choose?

You would be hard pressed to argue that health care is more important than food, shelter and clothing. Yet we have no general expectation that government should provide any of the three; in fact we're plenty happy without government interference in those decisions, with the exception of making sure everybody's playing by the (thankfully limited) rules.

Government involvement invariably leads to two things: a one-size-fits all program (think Social Security) or one that's needlessly complex (think everything else), with both costing more than and performing worse than the private equivalent. And both are going broke at an increasingly rapid rate, which should undermine the patina of security the government allegedly provides.