It's often true in democracies that problems don't attract attention until they become crises, if then. It took the Great Depression before Washington created insurance for bank deposits, unemployment and old age; a civil war before it ended slavery.
Crisis is the word for the American health insurance system, but you'd only know it by listening to the Democrats running for president. Republicans, thus far, are happily -- or is it nervously? -- ignoring the train that is bearing down on them.
A recent story in The Buffalo News drove home the point, which has become obvious to most Americans in recent years. Health insurance premiums -- usually paid by employers, workers or both -- have been climbing astronomically in recent years and 2008's are coming in with spikes as high as 25 percent. The soaring costs are eating into business profits, individual quality of life and, most ominously, into the caliber and even the availability of insurance, as increasing numbers of businesses scale back coverage or drop the benefit altogether.
Such hyperinflation is unsustainable in any circumstance, but in this case it is even worse than it appears, given that the quality of care Americans receive is about the same as citizens of other countries get for much less money. It may be convenient for Republican presidential candidates to ignore that fact, but endorsing wastefulness is hardly conservative.
Republicans argue that any time government gets involved in an issue, it makes matters worse. It's an overstatement, but the general point is well taken. Government is a blunt instrument, given to red tape and not renowned for efficiency. It is more likely to tolerate incompetence and seems more prone to corruption.
But what happens when the private sector has already made a hash of matters? When more and more Americans are going without insurance or facing bankruptcy as a result of illness? When the cost of premiums, already crushing, rises as much as 25 percent? Surely, then, the risk of government involvement is less than the risk of letting the whole thing crash.
The fact is that millions of Americans already have government insurance, through Medicare and Medicaid. Congressmen -- even Republicans -- have it through their work. Americans have government law enforcement, government fire protection, government water delivery and government road-building. The idea that government must, at all costs, stay out of the resolution of the massive and growing problem of health insurance is preposterous on its face.
Ignoring this matter will not make it go away. Nor will it make Republican presidential candidates safe from the sense that they live in another world than millions of voters in both parties. Even business leaders, a traditionally Republican constituency, want something done to relieve them of an expense that puts them at a significant disadvantage with their international competitors.
The Democratic candidates have plans to reform health care, and if they are mainly incremental in their approach, they would make a noticeable difference. Republicans are still not talking. They had better start now or prepare to look unserious when next year's presidential debates begin.