The problem is that you can’t entirely believe Obama. If he were candid — if we were candid — we’d all acknowledge that the goals of our ideal health-care system collide. Perhaps we can have any two, but not all three.

If we want universal insurance and unlimited patient and doctor choice, costs will continually spiral upward, because there will be no reason or no one to stop them. We have a variant of that today — a cost-plus system, with widespread insurance and open-ended reimbursement. Higher costs push up premiums and taxes. That’s one reason health spending has gone from 5 percent of gross domestic product in 1960 to 16 percent in 2007. (Other reasons: new technologies, rising incomes.) But controlling spending requires limits on patients and doctors…

The candor gap reflects a common condescension. One side believes it must fool Americans into thinking “reform” will do more than it will; the other thinks it must frighten Americans into believing that it will harm them in ways that it won’t. Given Americans’ contradictory expectations, any health-care proposal can be criticized for offending some popular goal. We refuse to face unavoidable — and unpleasant — choices.