Leif Wellington Haase, the director of New America's California Program and the author of "A New Deal for Health: How to Cover Everyone and Get Medical Costs Under Control," shares his thoughts in this Sunday's New York Times Magazine article on health care spending and rationing.

So long as U.S. medical costs have gone up rapidly, and in particular since the early 1970s, policy analysts, health economists, and medical ethicists have debated the balance between extending an individual life and paying, in effect, for better health for the many. The proliferation of medical technologies, some of which can extend a lifespan by a limited amount but at an enormous marginal cost, has revived this discussion.

It is an important debate, one joined this past weekend by Princeton philosopher Peter Singer in the New York Times Magazine, in an article titled "Why We Must Ration Health Care." The Australian-born Singer, best known for his controversial views on euthanasia and abortion, breaks no new ground here. Victor Fuchs (Who Shall Live?), Henry Aaron (Can We Say No?), Daniel Callahan (False Hopes), David Kindig (Purchasing Population Health), and others have laid the groundwork both for making ethical choices at the margins of modern medicine and constructing a rational framework for making choices among these competing goals.

It's useful to be reminded of the trade-offs associated with the record of medical success that, in part, has made the question of how to finance health reform so vexing. But it is critical to realize that the debate over rationing is largely a red herring. It is mostly irrelevant to the ongoing political and policy debate over comprehensive health reform -- how to expand coverage and keep down costs. Were we trying to halve U.S. spending on health care, it might be relevant now. But we aren't, and it isn't.

To take only the most obvious examples, studies of regional variations in U.S. medical care show that up to one-third of medical spending may be wasted -- some $700 billion a year that doesn't have any positive impact on health. Perhaps hundreds of billions are spent on unnecessary administrative costs by insurers and doctors. Simple steps, such as preventing avoidable hospital-acquired infections through better hand-washing protocols could save lives and save billions of dollars. And the existing practice of reimbursing doctors and other providers on a fee-for-service basis, rather than paying for episodes of care, results in unfathomably higher costs with no discernible improvement in health outcomes.

These systems failures are the main obstacles to getting value for the massive amounts we spend on medical care. Until we tackle them in earnest, it makes no sense to get distracted by largely philosophical arguments over potential restrictions on access to care and patient choice. The current health reform debate is not about rationing. It's about saving money, improving quality, and covering all Americans.

To be sure, it is prudent to make plans for the handful of new high-cost medical procedures and drugs that are coming to market and can impact medical spending in their own right. That's one big reason behind the push to study the comparative effectiveness of treatments, routine in other countries, that was included in the stimulus package this spring and in most comprehensive health reform proposals.

It makes sense to think about ways to reduce our indiscriminate spending on treatments of little additional worth, as with many other ways to increase the value of U.S. medical spending. But we shouldn't confuse seeking better value and health outcomes for our dollars with largely philosophical issues. Raising the spectre of rationing in this way is confused at best and intentionally distorting at worst.

One final thought: it is worth noting that Britain's National Institute of Clinical Excellence, like other bodies charged with reviewing the effectiveness of treatments, recommends expanding the use of new procedures and drugs far more often than it recommends not paying for them. Explicit rationing is used far, far less in most developed countries with dramatically lower levels of health spending than some opponents of expanding access to health insurance would have Americans believe.