For every dollar's worth of health care that Americans received last year, they paid a dime and somebody else paid 90 cents. If you bought food the way you buy health care—where 90% of everything you put in your basket was paid for by your grocery insurance policy—you would eat differently and so would your dog. We have the best health-care system in the world, but as rich as America is we can't afford it.

Any real debate about health-care reform has to be centered on solving the problem of cost. Ultimately, there are only two ways of doing it. The first approach is to have government control costs through some form of rationing. The alternative is to empower families to make their own health-care decisions in a system where costs matter. The fundamental question is...