"And in the end, unless patients are willing to accept the consequences of all these clichés—which is to say, sometimes they will not get costly treatments they think they deserve—none of these promises will be worth the price of a used bedpan." Precisely. This is the hard truth that even the most trusted politicians fear to speak. Universal coverage requires rationing by rules, as in Canada and England, or by price, which Americans probably dislike even more. If Obama won't come out and ask us to sacrifice, how can he expect us to accept the sacrifice? Is it too much to ask to have political leaders who will level with the voters? Apparently so, at least for now. No President since FDR has asked Americans at large to sacrifice anything of any consequence. It's always free goodies paid for by the tooth fairy.