It would appear that Congress will enact some form of health care legislation over the next few months. The exact form of that legislation and the extent to which it conforms to the plans discussed by President Obama during the election campaign remain uncertain. It does appear that the goal of any legislation Congress eventually enacts will be to provide at least minimal health coverage to most Americans, if not to every American.

In theory the extension of a minimum acceptable level of health coverage to the majority of Americans is a laudable idea. But, as in so many things, the devil is most certainly going to be in the details. To my mind there are several crucial issues which will not be at all easy to resolve to the satisfaction of many of us.

The first issue about which I worry is the extent to which the federal government assumes a more active role in providing health care to individual citizens. When one looks at the efficiency and competence of large scale federal government projects since the Second World War it is difficult to feel great confidence in the idea of the federal government attempting the massive task of becoming a universal health care provider.

Simply the problems of scale, geographical and economic, make the idea of a federal national health service quite problematic. Add to this the fact that large bureaucracies tend usually to allow individuals to “fall through the cracks,” particularly those who cannot or will not comply with the paperwork demands that most bureaucracies create, must give us all pause.

The second issue which all Americans must worry about is cost. It is already becoming apparent that any large-scale expansion of medical coverage in the United States will be immensely expensive. We are already facing a frightening federal deficit, one which promises only to increase in the near future. (I am afraid I simply do not believe Washington’s promises that the deficit will be reduced over the next five years.)

If the federal government takes on the costs of a new, expanded health care system and simply adds these costs to the deficit, the time will soon come when a $1 trillion deficit looks good. The president’s attempts to force medical providers to help finance more health coverage have already proven controversial and may, in fact, be impractical.

Taxing employer-provided health care benefits also would be quite problematic. It will directly harm America’s middle class, a group already financially challenged by the current recession. The politics of such a tax also will be difficult, at best, because labor unions, which fought so hard over the past decades to obtain health benefits for their members, will be particularly opposed to such a tax.

A third major issue with an expanded federal health care system is privacy. The more involvement the federal government has in individual health care, the more likely that the government also will have access to individual medical records. I believe that the federal government already has far too much access to individuals’ information. I simply do not want the federal government to have greater access to any individuals’ records. The potential for abuse is far too great. The potential for inadvertent disclosure is also far too great.

The next few months will be a critical time for the future of health care in the United States. I want to see expanded coverage, but I do not trust Congress or the executive branch to shape that future on their own. Health care is far too important to be left solely to the politicians. I hope that the medical profession and health care providers, in general, as well as corporations and small business owners raise their voices now and make sure that those in Congress know what Americans really want and need in health care before they enact a sweeping legislative program.