Amid all the controversies over medical care, no one seems to be asking a very basic question: Why does it take more than 1,000 pages of legislation to insure people who lack medical insurance?

Despite incessant repetition of the fact that millions of Americans do not have medical insurance, hardy souls who have actually read the mammoth medical care legislation being rushed through Congress have discovered all sorts of things there that have nothing whatever to do with insuring the uninsured– and everything to do with taking medical decisions out of the hands of doctors and their patients, and transferring those decisions to Washington bureaucrats.

That’s called “bait and switch” when an unscrupulous business advertises one thing and tries to sell you something else. When politicians do it, it is far more dangerous to far more people.

Deception is not an incidental aspect of this medical care legislation, but is at the very heart of it.

That such a massive change of the entire medical care system, from top to bottom, was attempted to be rushed through Congress before the August recess– before anybody in or out of Congress had time to read it all– should have told us from the outset that we were being played for fools.

Despite President Obama’s statements that he is not advocating a “single payer” system for medical care– which is to say, a government monopoly of power over life and death decisions– just a few years ago, he was telling a union audience that he was in favor of a “single payer” system. At that time, he pointed out that it was unlikely that such a system could be put in place all at once, that it might take a number of years to advance, step by step, to that goal.

In other words, Barack Obama fully understood the “entering wedge” political strategy that has allowed so many government programs to start off small, and apparently innocuous– and then grow to gigantic size and scope over the years.

If telling us that he is not for a single payer system will soothe us into going along, then it is perfectly understandable why he said it. But that is no reason for us to believe him.

As for those uninsured Americans who are supposedly the reason for all this sound and fury, there is remarkably little interest in why they are uninsured, despite the incessant repetition of the fact that they are.

The endless repetition serves a political purpose but digging into the underlying facts might undermine that purpose. Many find it sufficient to say that the uninsured cannot “afford” medical insurance. But what you can afford depends not only on how much money you have but also on what your priorities are.

Many people who are uninsured have incomes from which medical insurance premiums could readily be paid without any undue strain. But they choose to spend their money on other things. Many young people, especially, don’t buy medical insurance and elderly people already have Medicare. The poor have Medicaid available, even though many do not bother to sign up for it, until they are already in the hospital– which they can do then.

Throwing numbers around about how many people are uninsured may create the impression that the uninsured cannot get medical treatment, when it fact they can get medical treatment at any hospital emergency room.

Is this ideal? Of course not. But nothing is going to be ideal, whether the current medical care legislation passes or not. The relevant question is: Are the problems created by the current situation worse than the problems that will be created by the pending legislation? That question never seems to get asked, much less answered.

No small part of our current medical care problems have been created by politicians who drive up the cost of medical insurance by mandating that insurance cover things that many people are unwilling to pay for.

Many of us are willing to pay for treatment of a sprained ankle ourselves, if we can get less expensive insurance to cover us just for catastrophic illnesses. But that is one of many decisions that politicians have taken out of our hands. There will be many more decisions taken out of our hands if Obamacare passes.

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