At the heart of the healthcare debate that will soon occupy Washington is a huge conundrum, says Peter Baker in this blog posting for the New York Times. It's one thing to say that it makes no sense for a country to spend so much on procedures that ultimately will do little to extend or improve the lives of those nearing death, Baker says, but as a personal matter, it's another to deny your own grandmother an operation that may at least make her last days more comfortable.