WASHINGTON -- Attacking real or imagined health care villains, though sometimes necessary and always fun, will not make health care more affordable today or tomorrow unless we also face hard facts and reform our system. It is broken and our leaders know it, but courage to talk about real solutions is scarce, so most stick to diversionary tactics.

The ultraliberals' diversion is to blame capitalism and greed, to pretend that employers could just pay more while insurers and providers could charge less, which would occur under the magic of total government control.

Marching toward that utopia while still dreaming, the Maryland General Assembly is poised to override Gov. Robert L. Ehrlich Jr.'s veto of a bill that would make Wal-Mart, and Wal-Mart alone, spend 8 percent of payroll on health care--roughly double today's spending, which is higher than the retail industry norm.

The archconservatives' diversions are too many to list, but their favorite is that health care costs too much because most people have too much insurance. That's right: Their secret magic dust is to make patients pay more, as if making poor people pay more for office visits and drugs will keep down the cost of specialist care in the hospital for the rest of us.

What they really want, of course, is to keep taxes low regardless of what happens to health care costs and to keep this issue off the national radar screen, for it's hard to keep pretending that the uninsured get the care they need when evidence mounts that they do not. They even die sometimes, to the continuing shame of our great nation.

Now Wal-Mart, because it is so efficient, can afford to pay more for health care. But suppose we made it pay more--then what? Prices would rise and wages would fall. This would hurt Wal-Mart consumers and workers, most of whom are low-income, the very group we are all trying to help. Don't believe me? Go there next year in the week before Christmas and see how grateful the customers are to get the bargains they can give their families.

Advocates of the Wal-Mart legislation say it will just come out of excess profits. We all wish life were this simple. There isn't enough profit in general retailing to hold capital, fund investment and pay for the health care General Motors can't afford any more.

Retailers, even efficient ones, don't grow profits effortlessly. They are brokers, selling in ever more competitive markets and paying the minimum necessary for workers. This kind of amoral market discipline keeps most profit margins small most of the time. Wal-Mart drives extremely hard bargains with suppliers around the world and is growing because of low prices, but as a percentage of sales, competition limits profits to less than 4 percent.

However, if the rage at Wal-Mart is misplaced, what is to be done? The reality is that our economy does not generate enough jobs that can support a living wage and health benefits anymore. Health costs have grown faster than wages for so long that fewer and fewer of us can afford health benefits on our own.

A family premium today costs 33 percent of the median wage. So half of all workers would have to give up more than one-third of their pay to guarantee health care access for their families. This imbalance, which worsens each day we do nothing, will not be solved by making Wal-Mart spend more for its workers. And making less-efficient, low-wage firms offer health insurance for the first time would only push more workers onto unemployment and Medicaid rolls.

Fixing the economy is hard, but we know a fair bit about how to fix the health care system: Require everyone to cover themselves, create a market in which they can do so fairly, subsidize those who need help and use information tools and better incentives to make our delivery system far more efficient than it is today so that we can afford to help those who need it, forever.

Diagnosing our health care situation is not difficult.

What we lack is the political leadership to level with the people. Perhaps that adult conversation can begin this week in Maryland.