The latest print version of U.S. News includes an interesting commentary from Michael Tanner of the Cato Institute titled “Not Enough Care to Go Around.”

Tanner lays out in simple terms the key issue to be resolved with controlling health care costs.

Any healthcare reform will have to confront the biggest single reason costs keep rising: The American people keeping buying more and more healthcare. At its most basic, no one wants to die. If a treatment can save our lives or increase quality of life, we want it. Therefore, in the long run, the only way to spend less on healthcare is to consume less healthcare. Someone, sometime, has to say no.

Take just one example. If everyone were to receive a CT brain scan every year as part of an annual physical, we would undoubtedly discover a small number of brain cancers earlier than we otherwise would, perhaps early enough to save a few lives. But given the scan’s cost, adding it to all annual physicals would quickly bankrupt the nation.

The real debate, therefore, is not about whether we should ration care but about who should ration it. Currently, that decision is often made by insurance companies or other third-party payers. Obama and congressional Democrats want to shift that decision-making power to the federal government. Some, frustrated by the insurance-based rationing of the current system, naively believe that putting the government in charge would mean unlimited access to the care they need and deserve. …

The reality, however, is that every government-run healthcare system around the world rations care. …

Free-market healthcare reformers, on the other hand, want to shift more of the decisions (and therefore the financial responsibility) back to the individual. People should have the absolute right to spend their own money on whatever they want, including buying as much healthcare as they want. And, if they are spending their own money, they will make their own rationing decisions based on price and value.

For more consumer-based reform options, check out Carolina Journal interviews with Regina Herzlinger and Sally Pipes.