Raleigh, N.C. ? It was hard to tell last week which was more important to Americans — the signs of victory in the second Iraq war or the dispute over admitting women as members of the Augusta National Golf Club and Tiger Woods’ bid for a third consecutive Masters’ championship.

Here, both stories lagged behind the raging dispute over the firing of the head basketball coach at the University of North Carolina and his possible replacement by Roy Williams, the mentor of the runner-up Kansas Jayhawks in the just-completed NCAA men’s basketball tournament.

It is easy to ridicule the mixed-up values system that elevates competitive athletics and the prestige of certain stars and coaches over what are literally matters of life and death. But as anyone knows, it is the hot sports items of the day that provide the topic of conversation during coffee breaks on Monday mornings in most factories and offices — not the state of the world or the prospects for the presidency.

This may be a sign of sanity in our society or a measure of how insulated we are from the hard realities of the world. But our preoccupation with what I would acknowledge, as a devoted reader of the sports pages and TV sports junkie, to be trivia makes it far harder for policy-makers to engage the public in the debates over matters of ultimate consequence.

That difficulty was the topic of conversation at a forum on health care reform last week at the UNC School of Public Health in Chapel Hill. It drew not only a variety of academic and think-tank experts but government policy-makers, insurance and hospital executives and other health care providers. I was able to attend only the final morning of the two-day meeting — coming in after the group had reviewed the major policy proposals now on the table and examined why the last major reform effort by the Clinton administration a decade ago had failed to produce any results.

But the conclusion of that earlier discussion, as framed by one of the participants, was that the larger issue of health care reform has never been put to the public in a way that mobilized broad consensus on the fundamental question: How high a value does this society place on access to quality health care and what are we willing to pay for it?

In one of the papers prepared for the “summit,” Jonathan Oberlander, a UNC political scientist, pointed out that the organized groups with a large stake in the existing health care system — physicians, hospitals, insurers, pharmaceutical companies, employers, unions and others — have far more of a voice in setting national policy than, say, the 41 million uninsured. As he noted, the same thing was true of this summit: Those with clear professional and economic interests in health care far outnumbered those directly or indirectly speaking for consumers.

That is not the only barrier to major reform, Oberlander pointed out. The political-governmental system, with weak parties and a fragmented congressional structure, creates multiple power centers and makes consensus far harder to reach. And a political culture deeply distrustful of government raises a high barrier to the kind of centralized health care systems found in most other advanced industrial countries.

Given all of this, most of the participants in the conference said it would be better strategy to build off the existing mixed system of health insurance, where most workers are covered through their workplace and retirees through the government, than to convert either to a system of government coverage for everyone or one of tax-subsidized individual insurance.

But even if major overhauls are not likely in the near future, the conferees had no difficulty listing interim steps that could eventually contribute to the twin goals of controlling costs and improving access to the health care system.

One thing that clearly needs to be done, for example, is to develop standardized measures of treatments so it would become possible to calculate the value of the services patients are receiving — especially those that are very costly. Another well-received idea was to test the tax-credit strategy, advocated by the Bush administration and some conservative think tanks, on a large enough scale to determine how well it actually might work as a supplement to employer-subsidized insurance.

In short, there are useful things to do, even in a time of tight budgets. But the status quo will not be broken in a major way unless somehow — perhaps through the coming presidential campaign — the public is mobilized for the fight. If people are ever stirred up about health care the way they are over the Masters’ green jacket or the men on the sidelines at basketball tournament time, something might happen.

— David Broder is a columnist for Washington Post Writers Group.