The whole health-care imbroglio thus far might be described as the ill-informed taking on the ill-prepared over a bill that does not actually exist.

You may apply ill-informed and ill-prepared to whichever side you choose, or simply alternate them as suits your mood. My personal favorite moment was when a fellow at a town hall meeting said, "Keep the government out of Medicare."

Actually, the debate is no longer about health care at all. Oh, sure, something will be passed that the Democrats can call a success, and the president will sign it. But it may or may not change much, and all the old arguments will likely go on and on.

Meanwhile, health care has become a proxy for a more fundamental discussion: that of the size and role -- and cost -- of government.

Suddenly a lot of people have noticed that federal deficits and liabilities are enormous, revenues (tax receipts) are falling, and the notion of piling on trillions more in the name of health care strikes them as foolhardy. This has come as a shock to a Congress long accustomed to spending money that is not there and being thanked for it by constituents who, until now, have been only too happy to participate in a generational Ponzi scheme.

It's hard to say exactly when or why the public decided that fiscal responsibility was important, but it seems as if bailing out Wall Street and auto manufacturers and flinging stimulus money to the winds has had an effect -- at least on those who didn't receive any of this largesse.

Whatever the reason, this discontent has manifested itself in all the fuss at town hall meetings, where cost and government intrusion have become more important than where someone will get his next physical.

In a sense, it is too little, too late. The libertarian dream of a cozy little republic, managed locally by honest, intelligent, apolitical citizens, went by the boards about 20 minutes after George Washington's inauguration.

Still, there are degrees. As long as Congress is merely handing out money, particularly when the recipients outnumber the donors, it is fairly easy to rationalize the process. But when, suddenly, there are strings attached to this money, and Congress threatens to insert itself into something as personal as decisions about individual health care, people who have been only too happy to cash Social Security or unemployment checks take note.

The hard fact is that the United States is no longer the colossus it was in the 20th century. The government does not have the means to provide limitless services to its citizens, at least not without massive tax increases -- which, even Congress recognizes, are the short road to a stunted economy.

We have to prioritize our objectives and allocate our resources accordingly. Our citizens seem to be coming to grips with this reality much more quickly than are our politicians. The health-care debate has become the catalyst for this broader discussion.

It is actually a good case to argue. The basic premise behind the House health-care legislation, whatever form it finally takes, is that the federal government can manage health care more cost-efficiently than the private sector. From the conservatives' standpoint, this flies in the face of 200 years of experience with federal management of virtually anything.

The liberals argue that those pesky insurance companies make profits, and, since government doesn't need to make a profit, it can manage the operations performed by insurance companies more cheaply than they can.

This goes right to the core of a debate as old as the republic -- back, in fact, to the tea tax and Stamp Act that helped start the American Revolution. Since our founding, the resolution of issues of control has almost always, eventually, fallen on the side of bigger government. It may well do so again; but at least this time people seem to understand the argument.

Fred Wolferman lives in Southern Pines. Contact him by e-mail at fwolferman@sbcglobal.net.