Over the past few years, much has been made about reform of our health care system. What the general population and most politicians don’t understand is that our system, as it exists now, is not so much a well-­organized structure of interconnected and interrelated parts, but a haphazard and loose association of multiple parties with differing agendas.

If you toss aside the secondary political gain associated with reform, there seem to be two main motivations for change. One is to provide affordable insurance coverage for more people, and the other is to control costs. One could argue that both of these goals cannot be accomplished simultaneously; yet they are both laudable goals.

As a younger man, when money became tight at my house, the solution was usually to work more. Now I opt for the spend-less solution. Unfortunately for the taxpayers, the spend-less solution is never given much consideration by the government, and it almost always opts for the work-more approach.

The big problem is that government does not work in the sense that it creates a good or service that can be sold for a profit—unless somehow one could capture all that hot air. So when the “work-more” solution is applied in government, it means they must raise revenue—usually through raising taxes.

The folly of this approach, as Margaret Thatcher observed, is that eventually you run out of other people’s money. Given the size of the deficit, it’s fair to say that we are already there.

Spending can be reduced without limiting meaningful care. There is enough waste and stupidity in the system to save a whole lot of money without declining bypass for everyone over 70. If this conversation can proceed without the Republicans railing about death panels and such, we might actually get to a solution.

It is generally agreed that the elderly are overrepresented in health care costs. When most people hear this the usual response is, “Duh.” Another piece of information that gets tossed around is that a huge amount of money is spent in the last year of life. Estimates vary and the exact number is not helpful for this discussion, because we usually can’t predict when someone’s last year of life will be.

I purchased new tires for my wife’s aging SUV this fall. I have the expectation that the vehicle can be driven safely for another 50,000 miles. If the engine unexpectedly fails this winter, the tire purchase will turn out to be a bad decision.