Most political and media discussions of medical care have an air of unreality reminiscent of Alice in Wonderland. There is an abundance of catch-phrases but remarkably few coherent arguments.

Let's start at square one. Why is there alarm about American medical care? The most usual reason given is because its cost is high and rising.

That is certainly true. We were not spending nearly as much on high-tech medical procedures in the past because there were not nearly as many of them, and we were not spending anything at all on some of the new pharmaceutical drugs because they didn't exist.

This general pattern is not peculiar to medical care. Cars didn't cost nearly as much in the past, when they didn't have air-conditioning, power steering and high-tech safety features. Homes were cheaper when they were smaller, had fewer bathrooms and lacked such conveniences as built-in microwave ovens.

We would like to have all these things without the rising costs that come with them. But only with medical care is such wishful thinking taken seriously, with government regarded as a sort of fairy godmother who will give us the benefits without the costs.

A cynic is said to be someone who knows the price of everything and the value of nothing. If so, then it is political cynicism to point to other countries that spend less on medical care, including some countries where there is "universal health care" provided "free" by their governments.

Just as medical care, houses and cars were all cheaper when they lacked things that they have today, so medical care in other countries is cheaper when they lack many things that are more readily available in the United States.

There are more than four times as many Magnetic Resonance Imaging units (MRIs) per capita in the United States as in Britain or Canada, where there are government-run medical systems. There are more than twice as many CT scanners per capita in the United States as in Canada and more than four times as many per capita as in Britain.

Is it surprising that such things cost money?

The cost of developing a new pharmaceutical drug is now about a billion dollars. Neither political rhetoric nor government bureaucracies will make those costs go away.

We can, of course, refuse to pay these and other medical costs, just as we can refuse to buy air-conditioned homes with built-in microwave ovens. But that just means we pay attention only to prices and not to the value of what we get for those prices.

We can even refuse to pay for so many doctors. But that just means that we will have to wait longer to see a doctor-- as people do in countries with government-run medical systems.

In Canada, 27 percent of the people who have surgery wait four months or more. In Britain, 38 percent wait that long. But only 5 percent of Americans wait that long for surgery.

Surgery may well cost less in countries with government-run medical systems-- if you count only the money cost, and not the time the patients have to endure the ailments that require surgery, or the fact that some conditions become worse, or even fatal, while waiting.

A recent report from the Fraser Institute in Canada shows that patients there wait an average of ten weeks to get an MRI, just to find out what is wrong with them. A lot of bad things can happen in 10 weeks, ranging from suffering to death.

Politicians may talk about "bringing down the cost of medical care," but they seldom even attempt to bring down the costs. What they bring down is the price-- which is to say, they refuse to pay the costs.

Anybody can refuse to pay any cost. But don't be surprised if you get less when you pay less. None of this is rocket science. But it does require us to stop and think before jumping on a bandwagon.

The great haste with which the latest government expansion into medical care is being rushed through Congress suggests that the politicians don't want us to stop and think. That makes sense, from their point of view, but not from ours.