One of the first lessons every medical student learns is, “When you hear hoofbeats, don’t think zebras.” The message is that, in most cases, the cause of an ailment is commonplace, not exotic. The same holds true for diagnosing the meteoric rise in health care costs. No need to search for zebras; the reasons are obvious and numerous. And, as in medicine, treating health care costs one symptom at a time will only create different symptoms, not cure what ails us. According to the most recent data from the Organization for Economic Cooperation and Development (OECD), the U.S. has the highest per capita health care spending among industrialized countries. In 2003, U.S. spending per capita ($5,635) was two-and-a-half times the comparable median for OECD countries ($2,280). It also represented a significantly greater percentage of gross domestic product (15% vs. 8%). One might argue that the costs are justified if they result in superior health outcomes. Sadly, they don’t. The U.S. routinely ranks lower than other countries in health outcomes such as infant mortality. A Save the Children report issued this month reveals that among 33 industrialized nations, the United States is tied with Hungary, Malta, Poland, and Slovakia with a death rate of near 5 per 1,000 newborn babies…better only than Latvia’s rate of 6 per 1,000. What are the obvious causes of our nation’s unprecedented health care costs? Let’s look at just a few: 1. The cost-shifting shell game If you’re lucky enough to have insurance, the insurer negotiates fees with the provider which may be less than the actual cost of the service. To make up the cost, the provider charges higher fees to those not covered by insurance. When those (uninsured) patients are unable to pay, the government may step in to make up the difference. The government, in turn, gets this money by taxing citizens and employers. So one way or another, with or without insurance, we are all paying the price (sometimes more than once) for our health care. 2. Maintaining the shell game There are hundreds of insurance companies, each with its own plan options, employees, offices, rules, regulations, forms, and procedures. All of this costs money. Almost a third of every health care dollar goes to administering the multitude of programs. 3. Not buying in bulk In Canada, and other countries, the government buys prescription drugs in bulk at a great savings, and passes those savings on to the consumer. In the U.S., the Veterans Administration buys prescription drugs in bulk at a great savings and passes those savings on to the consumer. During the anthrax scare, when Tommy Thompson was Secretary of Health and Human Services, he purchased large quantities of the antibiotic Cipro in bulk at a great savings to the government, and the taxpayer. But Medicare, the single-payer health insurer for all of our nation’s seniors, is prohibited by law to purchase drugs in bulk at a savings and pass those savings on to the consumer. Allowing Medicare to buy drugs in bulk is one of the first priorities of the new Democratic majority in Congress. 4. An ounce of prevention… With 46 million uninsured in this country and millions more underinsured, millions of Americans do not have access to routine preventative care and early treatment that could result in good health and lower costs. Consequently, emergency rooms are flooded with those who have nowhere else to turn when seriously ill, and no means to pay for the care once there. Moreover, a simple infection that might have been treated easily with an inexpensive antibiotic for an out-patient, can then become a many thousand dollar, life or death, heroic effort to save a life. Health care for all, from cradle to grave, would actually keep our population healthier and more productive for more years than our current “shell-game” situation. 5. So many reasons, so little space We don’t have the time or the space to go into details on the overuse of services, the duplication of services, fraud, and other factors that all contribute to the unnecessarily exorbitant and inherently unfair cost of health care in this country. It’s been seven decades since President Harry Truman first called for health care for all in this country, but we still have an inadequate health care system. I renewed the call for health care for all during my first campaign for Congress, eight years ago. And I still believe that a single-payer system is the antidote to the dreadful condition in which we find ourselves. Under a single-payer system, all Americans would be covered for all medically necessary services. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care. A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting, and bulk purchasing. But, my years in Congress have also shown me that no single health care reform proposal, not a single-payer plan nor the more conservative, employer-based programs, have any chance of gaining the majority of votes necessary for passage at this time. There is no majority opinion, much less unanimity, as to what will work best. With this in mind, I’ve crafted a groundbreaking, bi-partisan solution to the health care crisis that can appeal to both conservative and liberal lawmakers. My Republican co-sponsor, Dr. Tom Price of Georgia, and I may disagree on the best means to the end, but we couldn’t be more united in our desire to move forward and provide the potential for true policy solutions. Joined by Rep. John Tierney (D-MA) and Rep. Bob Beauprez (R-CO), we have introduced H. R. 5864 – the Health Partnership Through Creative Federalism Act, a serious, bipartisan effort to break the logjam in Congress and develop plans to ensure health care coverage for all. This collaboration is rare, gratifying, and a sign of meaningful progress. We believe the federal government should be helping the states as they try new approaches, not hindering them. But, our bill does not throw a bunch of money at the problem of the uninsured. We’re looking for systemic change and encouraging innovation. Our plan would allow the potential for freedom from certain federal regulations and authorizes grants to individual states, or groups or portions of states, to enact the strategy best suited for them to ensure greater health insurance coverage. The costs of health care will never be controlled until we, as a nation, make a commitment to guarantee health care for all and then make that happen most efficiently and economically.