Health care has often been debated as a technical or economic issue. That has been a mistake, I believe. At root, universal health care is not an economic or technical question but a moral one.

We accept that life is unfair, that some people will live in cramped apartments and others in sprawling mansions. But our existing insurance system is not simply inequitable but also lethal: a very recent, peer-reviewed article in the American Journal of Public Health finds that nearly 45,000 uninsured people die annually as a consequence of not having insurance. That’s one needless death every 12 minutes.

When nearly 3,000 people were killed on 9/11, we began wars and were willing to devote more than $1 trillion in additional expenses. Yet about the same number of Americans die from our failed insurance system every three weeks.

The obstacle isn’t so much money as priorities. America made it a priority to provide tax breaks, largely to the wealthy, in the Bush years, at a 10-year cost including interest of $2.4 trillion. Allocating less than half that much to assure equal access to health care isn’t deemed an equal priority.

The plan emerging in the Senate is no panacea. America needs to promote exercise and discourage sugary drinks to hold down the rise in obesity, diabetes and medical bills. We need more competition among insurance companies. And conservatives are right to call for tort reform to reduce the costs of malpractice insurance and defensive medicine.

But those steps are not a substitute for guaranteed health coverage for all Americans. And if health reform fails this year, then hopes for universal coverage will recede again. There was a lag of 19 years after the Nixon plan before another serious try, and a 16-year lag after the Clinton effort of 1993. Another 16-year delay would be accompanied by more than 700,000 unnecessary deaths. That’s more Americans than died in World War I, World War II, Korea, Vietnam and Iraq combined.

The collapse of health reform would be a political and policy failure, but it would also be a profound moral failure. Periodically, there are political questions that are fundamentally moral, including slavery in the 19th century and civil rights battles in the 1950s and ’60s. In the same way, allowing tens of thousands of Americans to die each year because they are uninsured is not simply unwise and unfortunate. It is also wrong  a moral blot on a great nation.