One of the horrible things about U.S. public schools is that they will not buy students any knee replacements.

No one likes to talk about it, but it’s true. That is one of the things we never thought about when we created the public school system — that the principals would have life-and-death power over our children’s health and that in every case, the principals would choose death.

OK, I admit this is silly. There’s nothing socialist or prying about a public school not paying for a medical treatment. A politician who advocated that public schools pay for students’ health care would be called liberal. Her conservative opponent would say, “Government is expensive enough!”

But is it any more socialist when a public health insurer doesn’t pay for something than when a public school doesn’t pay?

The Republicans have been chilling the public’s blood with a story as horrific and false as anything told around a campfire: Since President Barack Obama’s health plan depends on stricter rationing for the people who have government health insurance, the government will have more control over our lives. Rationing simply means that the government won’t pay for certain procedures.

Is that so meddling? In order for us to call it “meddling,” doesn’t the government have to actually stop people from buying something? Or is just refusing to pay enough?

It is a sad day when people can’t distinguish “not receiving something for free” from “not being allowed to have something.”

Obama simply wants Medicare, the government health insurance that covers all senior citizens, to ration our tax dollars based on decisions made by panels using cost-effectiveness data.

These panels are the basis for the “death panels” that Sarah Palin is afraid will kill her children.

Palin’s fears are overblown, but it is possible that Medicare will make decisions that let some people die when their conditions are costly to treat and their life expectancy would be low with the treatment, anyway.

It sounds bad, but surely there is a limit to the amount of tax dollars we are willing to spend on someone’s health care. New, more expensive procedures come out every day. If the alternative to rationing is paying for whatever new procedure could conceivably yield social benefit, the government will go the way of Lehman Brothers, which paid for any mortgage that could conceivably yield a profit.

But the weird thing is that it’s Republicans who are up in arms about these cuts in spending.

Normally, they would endorse cuts to any agency except the military. Why do the Republicans feel health care for the elderly is a cause for which taxpayers can spare no expense?

I believe it is a case of guilt by association.

Rationing is something that countries with socialized medicine inevitably have to do, or go bankrupt. And because Republicans are against socialized medicine, they are against rationing. What Republicans don’t recognize is that we already have socialized medicine for our elderly.

So, by ignoring the fact, we are choosing the bankruptcy option, not avoiding the choice.

Of course, Obama doesn’t just advocate rationing for its own sake. He wants to use the savings from Medicare rationing to cover more of the uninsured.

But this aspect of Obama’s plan shouldn’t really divide liberals and conservatives. Their divide revolves on the question, “Will we have bigger or smaller government?”

But here we are talking about a fixed amount of money that we can push around the budget. So the rationing debate revolves on the question, “Will the government buy unlimited coverage for a few people or more basic coverage for many people?”

Rationing isn’t the only, or even the primary, source of money for Obama’s plan to expand coverage, though. He also wants to raise taxes, to pick up the slack left over from rationing.

So, in a sense, we can draw two spectra: One spectrum is, “How much does the government spend on old people vs. other people?” On another spectrum is, “How much will the government spend overall?”

The two questions do not have to be related. A Republican can oppose tax hikes but still support expanding a very basic level of coverage to all Americans — paid for with savings from rationing Medicare.

Eventually, a health plan will pass.

But if Republicans use all their force to oppose only the rationing aspect of health care reform, then we will receive an abominable compromise that should be Republicans’ worst nightmare: a plan that expands coverage but doesn’t limit spending. This pairing would necessitate sky-high taxes in the long run.

In the end, there are only two things we can be sure of in life. And by trying to shield us from death, Republicans are going to make us very cozy with taxes.

E-mail Lewis at [email protected].