Liberal politicians believe the resolution of the crisis lies in government programs to fund and deliver health care. Many of these people favor a single-payer socialist government health plan, such as that of Canada.

Some “conservative” politicians search for their own solutions, offering what sounds too much like “socialist-lite” programs.  They cry for expansion of government health insurance for more children and systems to help people purchase insurance through a government agency, rather than from a licensed insurance agent.

How things changed

In 1960, 48 percent of health care expenses were paid out-of-pocket by individuals, and the balance came from insurance and government programs.

The federal government decided to drive down the 22 percent uninsured rate to zero by creating two massive programs.  In 1965, Congress created Medicare to pay for health care for those who are 65 or older; and they created Medicaid to purchase health care for those considered to be low-income.  Immediately thereafter, health care spending spiked higher, at double-digit rates.

In 1965, Congress predicted that by 1990, Medicare spending would spike to $9 billion a year.  Instead, Medicare spent $57 billion in 1990, and more than $408 billion in 2006.  This is what happens when health care is “free,” or “nearly free” to those who use its services.

By trying to solve the health care crisis of the 1960s, Congress created the health care crisis of the 1970s, so it created Health Maintenance Organizations (HMOs).  It made the crisis worse, as spending continued its rapid growth, and HMO and insurance premiums began to follow.

During the 1980s, Congress again stepped in to "solve" the health care crisis.  The uninsured rate now became trumpeted as a measuring stick, as it had risen to something north of 40 million residents, according to the U.S. Census Bureau. In 1959, “The New York Times” asserted that the uninsured numbers 52 million, and almost 22 percent of the population.  Yet 1980s politicians had found a new national crisis in these far better numbers (if they were, indeed, even true).  The politicians opted for restructuring hospital billing, and creating yet a new concept: managed care.

When the 1990s health care crisis hit, the uninsured rate had soared to “45 million,” and Mrs. Bill Clinton took it upon herself to solve the crisis.  Her answer would have created a massive federal health care bureaucracy, and the voters understood it.  They threw-out the Democrats as a result, and nearly cost Mr. Clinton his reelection.  Yet, while the federal government seemed to step back, state governments stepped up their assault on market solutions to the 1990s health care crisis.

And so, here we are today

By 2005, only 12.5 percent of health care was paid out of pocket; governments spent 45 percent of the health care dollar to buy services for 25 percent of the people. Most of the remaining 75 percent of the people had their health care expenses paid by someone else, primarily health insurance, usually purchased for them in part or in whole by their employers.

We’re told there are 47 million uninsured (although the U.S. Census Bureau confesses that it has been miscounting for at least five years). Health care spending has continued to soar, to just more than $2 trillion a year, representing 16 percent of the Gross Domestic Product. That spending has driven the cost of health insurance higher.

I’m from the government and I’m here to help

State and federal governments have a long and sordid record of failure in solving the real dilemmas facing how to pay for health care, and ways to deliver it. Yet they are a persistent group, ever-hungrier to appease voters, even if the solutions they offer make the problems worse.

Today, politicians focus on the uninsured, and suggest that solving that problem will resolve what ails U.S. health care.  They are wrong, again.  For the United States faces a health care “spending and paying” problem, and the uninsured rate is, at best, a symptom of two other primary causes.

We search for and support political leaders who are willing to champion a full-frontal attack on these two primary causes.  Ironically, by doing so, they will reduce their own political power, and as such, would show us that they are true servants of the people.

Two sensible solutions

There are only two sensible ways to resolve what really ails U.S. health care. And they are directly correlated.

Consumer-directed health care

The most significant value of a high deductible health plan and an HSA is this: You become a better health care shopper, and you pay attention to what you spend.

And here is the best part.  Since with a high deductible health plan you now see what health care cost, you are incented to quite smoking, control alcohol intake, and lose weight.  You want to become healthier because you are now spending your own money.

The best thing about consumer-directed health care is that it reduces the role of politicians in making decisions about your personal life.

A Few FACTS, not fiction

FACT: The U.S. health care system serves the most diverse population of any country in the world.  Our statistics are affected by that diversity.  Black women, for a variety of reasons, are more prone to underweight babies than are Caucasian and Asian women. Consistent genetic lineage also contributes to Sweden having a lower infant mortality rate and Japan having a longer life expectancy. These factors must be taken into account when comparing statistics around the world with U.S. statistics.

FACT: There is a direct correlation between two parent, marriage-based families and lower infant mortality rates.  We need to do everything we can do to support and maintain traditional marriages. 

FACT: Not every country defines “life birth” as strictly as we do.  Here, it means any sign of life in the umbilical cord, any brain activity, or any muscle movement. If the baby shows any of these signs of life, and then dies, it counts against our infant mortality statistics.

FACT: The true number of chronically uninsured Americans is 3-5 percent of the population, not 15 or 16 percent.

FACT: Seventy-five percent of the uninsured are uninsured for less than a year. Uninsurance is temporary.

FACT: The largest group of uninsured U.S. residents is made up of temporary/seasonal workers, mostly of Hispanic/Latino origin, who are born in a foreign country.

FACT: U.S. and state taxpayers spent more than $500 billion in 2006, paying for health care services for low-income and uninsured residents.

FACT: Mandatory insurance laws always fail.  Some 25 percent of Californians fail to buy auto insurance, even though the law says they must, and about 20 percent are without health insurance, though it is a voluntary purchase.  In Minnesota, in 2003 some 17 percent of auto owners were uninsured, but only seven percent of Minnesotans were without health insurance. Hawaii has had mandatory health insurance for three decades, but more than 10 percent of its population is without health insurance.

FACT: In the United States, we do spend more than any other country in the world on health care.  We also spend more than any other country in the world on houses, cars, food, TVs, telephones, designer clothes, and a whole host of consumer products. We spend because we can, and after we spend on necessities, we have more left over to spend on health care than any other country in the world.

The question is not if we can spend money on health care, or even how much we spend, it is on how we spend it. We can be more efficient. We can get more value for our health care dollar, and we ought to do. But it will never happen if politicians design a federal or state program to do it.

Dave Racer is the co-author of two national books on health care, and speaks across the country at health care forums. See http://www.freemarkethealthcare.com for more information.