As do most Americans, I have a lot of questions about the health care proposals that are being considered in Congress, and I'm having a hard time finding answers.

The first question that comes to mind is the actual nature of the health care crisis. I know there are more than 45 million people who are not covered by insurance or some other program, but what does that mean? By law, everyone can get emergency medical care by walking into a hospital. I've also been told by medical professionals that the poor, indigent and those without insurance can get treatment either through government supported clinics or, most often, free or modestly priced facilities run by the medical profession itself.

I can remember when this debate first centered around everyone getting basic health care. My guess is that we have pretty much accomplished that, and I'm puzzled as to how this evolved into a discussion about universal insurance coverage, which is quite different. There is no question some people are not getting necessary medical care but are we taking a shotgun approach when a rifle would work?

Another question for me is what level of care do we intend to guarantee for everyone under any program? We're probably in general agreement that emergencies, severe sicknesses and other ailments needing immediate attention should get treated. But what about maladies on the other end of the spectrum? Can we guarantee everyone a heart transplant who needs it? Liver transplants? Kidney dialysis? Elaborate cancer surgeries? What about diseases that require extensive treatments with low chances of success? What about surgeries designed to improve quality of life to correct problems that are not life threatening? I'm not arguing that we shouldn't cover these, but I think we need to recognize there is a potential for this getting quite expensive in a hurry. Then again, maybe not, but it is not being discussed.

Don't we need to define carefully what we see as basic health care that we will guarantee everyone? If a new health program winds up being extremely expensive, are we willing to raise taxes to pay for it or reduce public expenditures elsewhere? Talk's cheap; health care is not.

If we are planning on using public funds to treat private illnesses, should we then put restrictions on lifestyles? The evidence is overwhelming that smoking causes a wide variety of health problems and can contribute significantly to medical expenses. Should those who don't smoke be expected to subsidize the medical care of those who have made a conscious decision to erode their health through a dangerous lifestyle?

And what about obesity? There's a lot of evidence to indicate strong links between obesity and poor health. My own physician regularly tells me every time I have a physical: Eat less and exercise more. If I choose not to do so and it results in health problems for me should public funds be used for my treatment?

Let me be clear that I am not taking a strong position on any of the questions above, only that I think these and others need to be addressed as we get involved in a national debate over the health care crisis.

Instead, what we have is a Congress racing to pass something with what appears to be very little discussion of the consequences, both intended and unintended. Further, right-wing columnists and squawk radio commentators exacerbate the problem by generating a lot of heat and very little light, but that's to be expected from them.

What is more troubling are the comments that we hear about "death panels" and "pulling the plug on grandma" from people who know better or, at the very least, should know better. The national discussion of health care reform needs to be taken to a higher level and the appropriate questions need to be discussed. Without doing this, the probability that we make any significant improvements may be greatly diminished.