WASHINGTON - Could it be the heat that's making people so angry and unreasonable at those town hall meetings on health care?
Red-faced retirees are railing against "government-run" health care and "socialized medicine" - with Medicare cards tucked inside their wallets. They could have just stayed home and harangued themselves. The August heat is punishing, but not enough to induce mass delirium.
We know that there are crazies in the town hall mobs - paranoid fantasists who imagine they hear the whop-whop-whop of the World Government black helicopters coming closer by the minute. We know that much of the action is being directed from the wings by cynical political operatives, following a script written by Washington lobbyists.
But the nut jobs and carpetbaggers are outnumbered by confused and concerned Americans who seem genuinely convinced they're not being told the whole truth about health care reform.
And they have a point.
It is not illogical for skeptics to suspect that if millions of people are going to be newly covered by health insurance, either costs are going to skyrocket or services are going to be curtailed.
The unvarnished truth is that services are ultimately going to have to be curtailed regardless of what happens with reform. We perform more expensive tests, questionable surgeries and high-tech diagnostic scans than we can afford. We spend unsustainable amounts of money on patients during the final year of life.
Yes, it's true that doctors order some questionable procedures defensively, to keep from getting sued. But it's a cop-out to blame the doctors or the tort lawyers. We're the ones who demand these tests, scans and surgeries. If a technology exists that can prolong life or improve its quality, even for a few weeks or months, why shouldn't we want it?
That's the reason people are so frightened and enraged about the proposed measure that would allow Medicare to pay for end-of-life counseling. If the government says it has to control health care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.
We should be having two debates. One should be about the obligation to ensure universal access to health care, which will directly benefit millions of struggling families and make this a better society.
The other - a more complicated, difficult and painful discussion - should be about the long-term problem of out-of-control health care costs, which would be a looming crisis even if President Obama had never uttered the word "reform."
• Washington Post columnist Eugene Robinson's e-mail address is eugener
obinson@washpost.com.