In the midst of having a national dialogue on race and class, perhaps it's time to launch one about civility.

You cannot conduct a dialogue between people of different backgrounds or differing opinions until you agree to listen first.

Frankly, I'm not sure, with all that President Obama has on his plate, that he needs to be solving racial conflicts or addressing police conduct, too. It was in the midst of trying to grapple with health care last month that one question railroaded the national dialogue.

Health and Human Services Secretary Kathleen Sebelius came to Philadelphia on Sunday to discuss health-care reform. She was accompanied by Pennsylvania's own political mood ring, Sen. Arlen Specter.

What she was treated to was relentless booing, perhaps an orchestrated grassroots effort by opponents but a dumb one at that. You do not boo the secretary of health and human services. Sebelius arrived at her position after being a successful centrist governor of Kansas. She knows far more about health care than most people.

You do not boo Specter, either. He knows more about health care than most people, too. Indeed, every time you open your mouth, you are not listening or learning.

A public health plan is not socialism, as critics roar. It is a choice. And the president has opened up the dialogue, by having a passel of congressional committees. consisting of members of both parties, elected by the American people, working on viable solutions.

Watch out for predators

If you are currently employed and insured, congratulations, you have won the health-care lottery.

The minute you're out there fending for yourself, best of luck. You're swimming with the sharks now. Specifically, you're swimming with insurance companies in the business of making big profits, whose executives regard the term preexisting condition as akin to leprosy or, worse, their own financial loss.

"They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit," former Cigna spokesman Wendell Potter told PBS's Bill Moyers. "So they don't want to compete against a more efficient competitor." Which would be a public plan.

A third of U.S. companies didn't offer health insurance in 2007, when the economy was in far better shape. Almost 90 million people, about one-third of the population under 65, were uninsured sometime during 2006 or 2007.

One thing America is producing in surplus is Americans without full-time employment, who go from being insured to uninsured or underinsured. Meanwhile, pharmaceutical companies and many hospitals remain focused on profits.

Time to talk

So this seems the best possible time to discuss better choice and public options, to create competition that might drive down administrative costs and profit margins, a boon to us all.

Our medical experts, technology, and hospitals are the envy of the world. Any ailing foreign mogul or sheik worth his Swiss bank account heads here first. Our coverage and care of all Americans, not just those lucky enough to pay, are another matter entirely, remaining the most expensive - the Gucci bags of medicine.

In 2000, the World Health Organization rated the United States' health-care system 37th, behind that of Costa Rica, two places above that of impoverished Cuba. A report by the respected foundation Commonwealth Fund last year reaffirmed that America has the world's costliest health care, largely due to $156 billion in annual administrative insurance costs, yet among eight industrialized nations it ranks last in preventable mortality.

So our health care is impressive, advanced, expensive, and sometimes deadly. Those fools can shout at Sebelius until they're hoarse, but it won't alter the inadequate situation we have now.

A country's success is based not on cumulative wealth or military might, but on the care and education of its citizens.

In this regard - and listen well - we are the envy of no one.

Contact columnist Karen Heller at 215-854-2586 or kheller@phillynews.com.