Is misplaced. The Ds and Rs rail about whose plan to rein in costs and deliver optimum care is best, while two-thirds of Americans are either overweight or obese. The debate focuses on the 95 percent of the health care dollar spent on clinical care – which accounts for about 20 percent of the determinants of health – while saying almost nothing about the social, psychological and physical environmental factors that account for the other 80 percent.

Rhetoric notwithstanding, the basic structure of America’s sick care system remains intact under both caricatures of a government or free market focus. Fee-for-service, ever more expensive medical devices and drugs, mega-cancer and other specialty facilities, and growing market consolidation on both the payer and provider side continue apace. The parallels with the “too big to fail” financial crisis of the recent past are striking.

Everyone acknowledges the current rate of medical cost increases is unsustainable, yet communities all over the nation tout investments in medical facilities, technology and labor as part of their economic salvation. Economic growth demands ever increasing consumption of more goods and services. When regulations are proposed to address issues of medical necessity, overuse or misuse, thousands of industry lobbyists descend upon Congress to protect the status quo. Einstein once remarked that “insanity is doing the same thing over and over and expecting different results.” That pretty much describes the current debate on “fixing Medicare.”

One thing seems certain: We are going to be paying more of our own money for health care in the future. If that’s true, then it is enlightened personal and social policy to address more effectively the 80 percent of personal, social and environmental factors that promote personal wellness and public health, and reduce overuse of an expensive and bloated sick care system.