Would Paul Masson approve of the progress of the health-care debate? Probably not. Democrats sold Clinton to the public partly on the strength of a long-overdue national health plan, but they never addressed these major problems that will afflict either of the two major proposals.

This doesn't mean that universal health care is a bad idea. It's not. It doesn't mean that managed competition isn't better than Canada's system. It probably is.

What it does mean is that something more fundamental than the tax code or the insurance industry has to change. We'll simply have to alter our conceptions about the American health care system. The AMA spokesperson says that Americans "have certain expectations...When you're told that you've got to wait six months for coronary bypass surgery, you get upset." This extreme case paints in sharp relief the potential shortcomings of universal care.

Given that most of us--the majority of Americans--can get health care on demand because we can afford health insurance, queuing up briefly while the new system begins to prioritize by medical need rather than financial strength may frustrate us. But this may be an inevitable consequence of health care reform.

There's a lesson here for policymakers, too. Sometimes politicians make decisions without the benefit of hard facts. The foibles of the Canadian system are well-documented, but managed competition is an unknown quantity. Health care is a big, technical, complex issue, and you can't talk about it without sweating all the numbers.

Universal care's time has come, but we've got to know what we're buying.