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The Washington Post, August 28, 2013

In 1963, when Martin Luther King, Jr. gave his "I Have A Dream" speech, America spent 5.5 percent of gross domestic product on health care. Today we spend 18 percent, while most other wealthy nations spend 10 to 12 percent through systems that deliver equal or better health outcomes. In a $16 trillion economy, our excess health-care spending—that is, money we devote to health care that plainly isn't needed for quality care—thus comes to a staggering $1 trillion a year.

Call this a trillion-dollar "diversion" or "opportunity cost." Call it a "rip-off." Or even "theft." Whatever the label, the point is the same: No leader commemorating the March on Washington and urging the nation to pursue our unfinished progressive agenda will draw a link between our out-of-control medical-industrial complex and the price of justice. They should.

In 1963, Dr. King said, "the Negro is still languishing in the corners of American society." Half a century later, if you want to know why too many Americans of every race and creed are still languishing, our outsized health-care costs, and the way they divert public and private resources from more urgent uses, are a big part of the explanation.

Can we summon the imagination to view our radically inefficient health-care system as a moral challenge?

Twenty million Americans today want full-time work but can't find it. We're told there's no room in the budget to put Americans to work rebuilding our run-down roads, bridges, airports, sewer systems and electrical grids. President Obama's Jobs Act, ignored by the Republican-controlled House, only sought enough funding for 1 million to 2 million such jobs.

Why? Because there's no money.

Millions of poor children lack access to the high-quality preschool that would give them a better chance in life. We can't give them such access because "there's no money."

Millions of poor children are warehoused in schools across the United States today with unqualified teachers. Still, the United States won't invest in making teaching an attractive career for our most talented young people, which is what nations with high-performing school systems, such as Finland, South Korea and Singapore, do.

Why not? Because, we're told, we don't have that kind of money.

Tuition at public colleges have soared to a stunning quarter of median family income. That's largely because state spending on Medicaid has skyrocketed over the last 30 years, forcing deep cuts in support for state colleges.

Average wages have been stagnant for years, in part because in our employer-based health-care system, soaring health-care costs have devoured all the cash businesses might otherwise have had available to give workers a raise.

"America has given the Negro people a bad check," King said in 1963, "a check which has come back marked 'insufficient funds.' But we refuse to believe that the bank of justice is bankrupt. We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation."

What would King have made of this needless overpayment of a trillion dollars a year? A trillion dollars not available for higher wages and better teachers. A trillion dollars we can't use for gleaming new infrastructure and world-class preschools. A trillion dollars that could dramatically lower the cost of college for every young American working to build a better future.

If the mob told us to hand over a trillion a year in protection money, we'd call the police.

If a conquering foreign power tried to extract a trillion a year in tribute, we'd revolt.

But when respected doctors in white coats and local worthies on hospital boards essentially hold America up for the same aggregate sum, we say nothing. We do nothing.

It's not as dramatic as Bull Connor and the hoses. The martyrs to excess health-care costs are less visible, and the links between cause and effect seem more attenuated. But in a world of scarce resources and trade-offs, every new merger lets hospitals hike prices helps deny poor children a fair start in life.

Our radically inefficient health-care system isn't a matter of accounting for the budget. It's a question of justice for the pulpit.

It will take creativity to frame these issues in ways that make the tumblers click and mobilizes voters to demand new answers. Advocates for young people, workers and the poor will have to give up their traditional unwillingness to meddle in other people's sandboxes when it comes to public funds. You can't play nice or "stay in your lane" when the stakes are this high.

Yes, I know, we'll never get a thundering MLK refrain here, but even a wonky columnist can have a dream.

"Cost-effective at last, cost-effective at last, thank God almighty, our health-care system is cost-effective at last!"

Fifty years on, with King's economic vision so far from being fulfilled, there's no choice. Getting serious about justice means getting serious about health-care costs.