The health care changes being debated won’t necessarily produce an oasis for uninsured patients, as we’ve imagined. Instead of advancing the world’s best health care system, based on patient outcomes, spending an additional 1.5-plus trillion deficit dollars will dilute private care in a mirage of expanded programs.

Medicare and Medicaid together pay the health care bills of nearly half of Americans, according to the Congressional Budget Office, while a majority of others hold private policies. Still, many younger Americans find insurance too costly and choose to go without it, so the Obama administration and Democratic congressional leaders propose to revamp the system to help them.

Critical to an effective system are adequate numbers of physicians and nurses. Even as numbers of patients swell, President Obama’s scholarships won’t increase the numbers of professionals before 2020. By then many physicians, overwhelmed by longer hours and cost-cutting, will have retired early. Medical school applicants may rethink their plans and choose other professions.

But an even bigger problem arises from the fact that those receiving health care services aren’t the ones paying the bills. Past practice was based on the primary doctor-patient relationship, with the doctor paid directly. Today’s employer- paid insurance, instituted to attract scarce labor during World War II, and government programs together enshrine the “third-party payer.”

When individuals don’t pay bills directly, the ensuing demand for unnecessary services leads to runaway costs. Regulations prohibit denial of essential medical services to anyone presenting a serious condition at a health facility receiving federal funds, citizen or not, regardless of ability to pay. Others pay those bills through higher fees, insurance premiums and taxes. Malpractice litigation causes insurance for physicians and hospitals to skyrocket.

According to Robert Samuelson, economics writer for the Washington Post, exorbitant awards, resulting defensive medicine and costs of computerizing record- keeping will outstrip savings from new technologies. The president and congressional Democrats insist their plan would rein in costs, but the only sure way to do that is rationing.

When taxpayers, not patients, are on the hook for medical bills, there is little incentive to economize. If patient and doctor won’t say “no,” some nameless bureaucrat — facing future shortages of doctors and facilities — will.

Glimpses into ObamaCare reveal creation of federal panels deciding who gets what medical procedures when, and which expensive drugs.

They will decide the medical treatments, according to former Sen. Tom Daschle, “providing the most bang for the buck” and limit access for patients not meeting strict cost-benefit criteria.

William D. Balgord, Ph. D., is a consultant and writer who heads Environmental & Resources Technology, Inc. in Middleton, Wisc.