Speaking of ethical issues in health care, imagine you are a Medicare official being asked to cover Provenge, a drug used to treat advanced prostate cancer. A normal three-infusion course of treatment is expected to cost $93,000. Studies showed men treated with the new drug lived an average of 4.1 months longer compared to a placebo.

Is the benefit worth the cost? You might get one answer from the Medicare official, another from the grieving spouse of the patient, another from the family who had to pay the $93K themselves, another from the 28,000-member American Society of Clinical Oncologists (yes), and still another from those who believe questions like this are the sole purview of physicians and their patients, and we don’t need a government panel on “comparative effectiveness” rationing our care.

Wrong. This is where the economic rubber meets the road. If we’re not willing to engage in a reasoned debate on cost effectiveness of care, we’re not serious about getting a handle on health care costs.