What we need is affordable health services for all Americans, including the one in six who don’t have all or part of their medical bills paid through existing public or private insurance.

Of course, we also need to pay off the national debt, end wars, feed children, make highways safer, develop reliable energy sources, improve schools ….

As voting day nears in the U.S. House, the national furor over H.R. 3200 is similar to the less filling, tastes great beer commercials.

Separate camps have staked out separate positions, which really aren’t in conflict.

That makes it hard, if not impossible, to find middle ground.

In beer terms, those who argue “less filling” aren’t saying the beer tastes bad. And those who argue “tastes great” aren’t saying the beer isn’t less filling. They disagree only on which matters most.

In the same way, those who await passage of H.R. 3200 with glee don’t say the effect on health care as we know it will be simple or cheap. They ignore those aspects. And those who await the vote with trepidation don’t say health care in America is perfect as is. They point to the cost and a well-founded fear of bureaucratic inefficiency.

“Confutation” is a wonderful word.

In classic debate, it means responding to an opponent’s specific arguments by showing them to be incorrect. To win a debate, a contestant doesn’t stop with advocating a position. It’s necessary to show, precisely, that the other contestants’ arguments don’t hold water.

Regarding health care reforms, very little confutation is going on. Those for or against insist on the correctness of their own viewpoints and that’s that. The expectation is that power politics will take care of the rest and that’s probably how this will play out.

The most amazing thing about H.R. 3200 is that it is being viewed as an “all of a sudden” piece of legislation. People seem to have forgotten the long-term, incremental aspects. This bill is the next big step, some would say the crowning piece of legislation, that sews up a process that has been under way since the first tax dollar was used to pay a medical bill for an American citizen. The intent is to extend to everyone services that have been available only to specific groups, the largest of which are those 65 and older enrolled in Medicare and those poor and disabled who are enrolled in Medicaid.

When those programs were begun, there were definitional needs, too.

Medicare, signed into law 44 years ago by President Lyndon Baines Johnson, answered the reality that too many pensioners were suffering or dying because they’d lost their private insurance when they retired and couldn’t afford medical bills that were rising in proportion with their age and advances in health sciences. Like Social Security, however, Medicare was supposed to be only a cushion. Out-year projections showed it would never, ever become the expensive program that burdened the federal treasury as it does today.

Medicaid, created in the same legislation as Medicare, answered the definitional needs that the poor and disabled were locked out of medical services, too. A difference was that states would match Medicaid dollars and could define coverages and limits. Today, Medicaid pays the bills of 68 percent of the 1.8 million residents of 17,000 nursing homes, an entire industry that did not exist 50 years ago.

Recently, a doctor practicing in Mississippi made an argument for simplicity, saying that if a fund were created and, on a sliding scale according to our financial means, $5,000 a year was put in for every American, there would be ample funds to pay for pills, office visits, hospitalizations, tests … everything associated with health care.

The doctor’s math was right, but history shows it hasn’t worked that way. Entitlements just don’t. Whenever our government has created programs, they have become “all you can eat” buffets. If a service is available and “free,” we use it. That’s not a bad thing. It’s just fact.

So it comes down to this: need vs. cost.

Step-by-step at least since 1965, America has been moving toward defining health care as a human right and a government obligation. Some think that’s right and some think it’s wrong, but it is the way it is. Medicare and Medicaid and all the other government programs are not going to be canceled.

Even if H.R. 3200 fails, the quest to close the loop won’t go away.

Visceral protests indicate great numbers of people are not ready to embrace “nationalization” of health care. An alternative view is that it’s a natural progression. The need is clear. The cost is clear. The only variable will be the timing.