One of the hurdles impeding health insurance reform is convincing those already with insurance that the changes will benefit them.

Indeed, according to most polls, more than 3 in 4 are satisfied with their own care, and according to The New York Times’ David Leonhardt, “Americans say they want change, but they also want to preserve their own status quo.”

But, the status quo cannot be preserved if we’re serious about controlling costs.

A recent editorial in the Washington Post shows the delicate situation facing the President. In his speeches, he glosses over what it means to cut costs, instead, referring to Matrix-like analogies of choosing the red pill or the blue pill when it comes to choosing medical treatments. But the situation is far more nuanced than that:

What if the pricey blue pill is actually better than the cheaper red one? What if it’s better but just a little bit? What happens when a yellow pill comes along, costing twice as much as the blue? What happens if there’s a new procedure that cures the ailment, but at an even bigger cost?

And there’s no doubt that cutting costs will require saying no, meaning the average patient will have to be affected. And that’s the conundrum facing reformers during this current iteration of reform.

In other words, having it both ways, wanting change yet maintaining the status quo, will be close to impossible if health care costs are truly to be contained.