I was reading an article about health care reform when my train pulled into the station. The platform was crowded. I looked around. It took just one quick glance to see the major missing piece in today’s great health care debate.

The people on the platform, a mix of young and old, black and white, richly dressed and otherwise, a perfectly random sampling of urban Americans, didn’t look all that healthy. One teenager appeared to be about five feet six inches tall and nearly as wide. And he wasn’t the only very overweight person on that platform. The men mostly slouched. The women, even the younger ones, seemed to be having trouble carrying not-that-heavy parcels. It might have been the light, but there was a distinctly pasty-faced appearance to many of those boarding as I exited the car.

Should there be a single payer health care system? Should we have a government insurer compete with private ones to hold down costs. Should the law passed by a Republican Congress that has Washington paying retail price for the drug purchases it makes for Medicare be amended? Should employer health insurance benefits be taxed to pay for those currently uninsured? All good questions. All well worth discussing.

But here’s the core truth that really matters here. There’s a demographic revolution going on in this country. People are living longer. Older people tend to need more health care and more costly health care. And the only long term way to address these rising costs, the only long term way with the slightest possibility of successfully addressing this economic challenge, is to make older Americans in the future healthier when they get older by helping them stay healthier while they are younger.

There’s a modest part of the Obama health care proposal that includes preventive measures. Great. There’s thousands of programs in individual schools around the country that get kids into better eating habits and get them to exercise more. Great. There’s many companies, tired of their own soaring health insurance bills, that have weight loss, smoking prevention, and exercise programs. Great.

The answers to future health care solvency are everywhere on view. What’s lacking is a truly coherent, universal, well funded effort by the federal government working through states, schools and employers to do what’s needed. This will cost money either directly via subsidies or with tax incentives. Bully platform propaganda will have to be backed up with an on-going media blitz. And this should not just be a Health and Human Services priority. Every agency of government must be brought on board to reinforce the effort.

Here’s the two two choices we have today when it comes to paying for future health care. We can get Americans healthier before they reach 60 and adequately finesse a future health care crisis. Or we can just play who-pays-how-much-for-doing-what games and end up bankrupting the republic. Bankrupting it 10 years later maybe. But bankrupting it nonetheless