America is long overdue for a serious debate about health care. Too bad it's not happening now.

Oh, there's lots of talk. People in power, pundits in the media and interest groups in the medical and insurance fields are expounding vigorously on the nation's health-care needs. But they're talking past each other to their own audiences, not listening to one another, let alone directly answering concerns — a political Tower of Babel.

What a shame it will be if that prevents the nation from solving the health-care crisis. And it is a crisis, though some choose not to see it.

In this area President Barack Obama has to step up as the communicator in chief. He's approaching health-care reform like a campaign, but he's falling into pat arguments that speak to believers more than naysayers. As one example, he needs to convince people that the reform he envisions won't come at the expense of medical innovation and the array of world-class hospitals and specialists that Americans who now have coverage greatly value. That's at the core of opponent's fears, and it's a legitimate concern.

The president needs to borrow a page from the Ronald Reagan can-do playbook. A nation that spends more than $2 trillion on health care every year should be able to provide coverage to every American and offer unparalleled quality of treatment and services. It should not be either/or. Yet that's how the non-debate is shaping up in Congress and in scare-tactic advertising campaigns.

It's stunning that the United States has by far the most expensive system in the world per capita but fails to provide coverage to nearly 50 million Americans. And the reasons are clear. Huge amounts of money go into overhead for private insurers. And the system rewards doctors and other providers who order and perform the most and costliest procedures, when it should provide incentives based on patient outcomes.

Changes have to be fundamental, starting with bringing medical information technology into the 21st century. Reforms should create a better focus on preventing and treating chronic diseases. They should broaden the use of nurses to monitor patients' medications and treatments, a proven method of not just lowering costs but improving care.

The most important transformation will be crafting national policies that reward doctors and hospitals for delivering high-quality care. The plan has to fund continual research on comparative treatment for conditions and diseases and distribute the information widely for review.

We need not mimic Europe or Canada, although the evils of their health care systems are being vastly overstated. Obama should be striving instead to create a uniquely American system that makes the most efficient use of private and public dollars for patient care and for medical research. The system will fail if we give up or even slow the quest for cures of devastating diseases.

Prudent management of health care dollars need not be in conflict with innovation or the practice of good medicine. Let America's health care debate begin there.