A grown-up conversation about health care is apparently out of the question when people like Rep. Dave Camp, R-Mich, are involved.

Without missing a beat, Camp decided to use the Preventive Services Task Force’s controversial recommendations on breast cancer screenings to gin up fear of rationing. And like many lawmakers, Camp wants you to know that he’s opposed it. “This is what happens when bureaucrats make your health care decisions,” he said.

Of course, bureaucrats already make our health care decisions — they just happen to be bureaucrats working for private insurers. Camp, as he surely knows, is not really opposed to rationing. Every health care system — including the United States — rations health care. If you are among the many Republicans who think we have the “finest health care system in the world,” then you are very much in favor of rationing. Every time a private insurer opts not to cover a procedure, that insurer has rationed a patient’s care. When insurers rescind a patient’s insurance policy because he or she has become too sick and too costly, that’s rationing. Lifetime limits on coverage? Rationing. The Pre-existing condition exclusion is one of the most inhumane forms of rationing imaginable.

Do single-payer systems ration? Absolutely. The method in which they ration is certainly imperfect, but they at least attempt to ration in a way that is logical and humane. Undoubtedly, they sometimes fail. Every health care system in the world has its individual horror stories.

The bottom line is this: if you don’t ration in some way, health care costs explode, accounting for an ever larger share of GDP. Families have to devote an unsustainable portion of their income to health care, and the standard of living declines. The question isn’t whether to ration, but rather how to ration.

The public, meanwhile, would be well served if members of Congress could summon the courage and discipline to debate health care policy like adults.

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