I watched a piece on Bill Moyers' Journal Friday that drove home the primary subject matter in this health care debate. "Money-Driven Medicine' makes clear the very real idea that at bottom the health care issue is a moral one, steeped in a wrangle between profit/commerce vs. access to care and the benefits of modern medicine for patients. The US system is based on the business of medicine, profits for insurance companies, and the ultimate problem that can only be addressed by real change: millions of Americans are deprived of health care for lack of ability to pay. In most of the industrial world, governments and health care folks have made it possible for all citizens to access the system. The 'Money-Driven' film also points out, via a group that works out of Dartmouth College to study these things, that not all systems worldwide are government-run. Some are run by private insurers, but the effect on the population is the same: nobody is denied access for lack of money, nor for pre-existing conditions. Which doesn't mean all health systems are without cost-cutting dimensions. But that becomes part of why they work so much better than the current US system: everyone gets the care he or she needs. It is a right of citizenship in the industrial first world; and the insurance company people who make 20% of the huge outlays of money in the American system, are reduced to around 4% in most other world health systems. The ethical challenge here is large and looming and ranks with the great social legislation in the national history, including Civil Rights and Voting Rights, Social Security, Medicare, and environmental issues. One hopes that the Democrats will find new wind in their sails, and face the moral dimension of this with a seriousness born of knowledge and the capacity to change the system to meet the needs of people before anything else.