We are in the midst of a vigorous national debate on health care, and we must get it right. One-sixth of our economy and our future as a nation are at stake.

I am not writing to propose specific solutions, except to state that the issues are far more complex and difficult than is reflected in the current debate and in pending legislation. We need health-care reform. But what is being discussed is insurance reform, just one piece of the puzzle.

An even greater concern, though, is the apparent absence from the discourse of the concept of individual and collective sacrifice for the good of the generations to come. Have we lost sight of our heritage?

The freedom, opportunity and prosperity that we Americans enjoy has been possible only because of our nation's tradition of individual sacrifice for the collective good. This has been a consistent commitment of the generations that have come before us, some being called to greater sacrifice than others, but all embracing the principle. We are the benefactors of that long heritage.

Throughout the great conflicts in our history, many have endured unimaginable hardships to give birth to a nation founded on a new ideal of government, and then to preserve and protect it. Many made the ultimate sacrifice.

We worry today about health-care rationing. In World War II, health care was rationed with a heavy hand because medicines and health-care professionals were needed abroad. Virtually every basic commodity was rationed, as well, from gasoline to tires to stockings. We honor those who lived through it, and those who didn't, as "our greatest generation." Why? It is in tribute to their sacrifice and courage.

In peacetime as well, ours has been a tradition of families forgoing comfort, security and leisure in order to provide their children an education so that they might enjoy a better future.

In today's health-care debate, some imply that we can continue on our current course because we are the wealthiest nation on Earth. In fact, we are the biggest debtor nation on Earth. For every one dollar that we earn as nation we spend two dollars. This is not prosperity; it is the illusion of prosperity. And it is economic suicide.

The debt which we have accumulated is both obscene and immoral, shouldering our children, our grandchildren and the generations to follow them with suffocating debt.

It is said about Medicare, "We can't cut back. It would be rationing. I earned it. I paid for it."

But the data are clear that we have neither earned it nor paid for it.

Our current national debt is nearing $12 trillion. A debt of such magnitude threatens the stability and future of our entire economy.

Yet this is dwarfed by the unfunded liability for Medicare, which, over the next 50 years or so, is conservatively estimated at $40 trillion. And this doesn't include $8 trillion for the Medicare prescription drug plan. Some estimates are higher.

This $48 trillion shows up nowhere in the projections of our budgets or our national deficit. And to it can be added the nearly $11 trillion of unfunded liability that we face for Social Security.

The bottom line: Medicare will change dramatically, despite any promises to the contrary, because it is a fiscal inevitability.

Why is almost no one in government talking about this reality as we debate health-care reform?

It is because politicians want to be re-elected. If there is any system in our country that is more broken than our health-care system, it is our political system. Politicians cannot get re-elected if they admit that it is impossible for us to provide what has been promised through our existing system of health care.

We as a nation spend far more per capita on health care than any other nation on Earth, by orders of magnitude. We do this with largely noble intentions. Patients want the best care for themselves and their families, which physicians want to provide. And every unordered test is a potential legal liability.

Yet despite this enormous spending, our outcomes are not as good as many countries that spend far less. We employ extremely expensive, high-tech health care in many situations for which there is no demonstrated benefit to patients.

Even within our own country, per-capita spending on health care, adjusted for age, varies regionally by a factor of as much as threefold, while there is no evidence that outcomes in areas that spend more are better than those which spend less. Still, we as a society consider extravagantly wasteful practices to be our right. But who will pay for it?

Based upon 30 years of clinical experience in medical practice, I am confident that we could cut enormous amounts of spending from Medicare without compromising quality of care, access to care or outcomes if we commit to fixing broken systems. It will be very difficult because systems are broken on many levels -- medical, legal, political, societal.

But rather than react in fear, we should rise to the challenge, as our forefathers have before us, with a willingness to come together as a people and to risk some sacrifice to build a better future for our children and grandchildren.

We would not sacrifice our health. All we would lose is our false sense of security in the status quo -- and the luxury of passing our debt on to succeeding generations.

I don't pretend to know all the answers to our health-care problems. But one answer is clear. We can solve this crisis only by carrying the burden together.

To do anything less is to disgrace the sacrifice of all those who have come before us. Let us stop talking about our rights and begin focusing on our responsibilities.

Cartoonist Rob Rogers does "Rob's Rough," an early look at his work and his creative process, exclusively at PG+, a members-only web site of the Pittsburgh Post-Gazette. Our introduction to PG+ gives you all the details.