Excellent observation.

I might add: health care itself, like government, is heavily staffed by American workers, and highly educated ones at that. It's fairly difficult to outsource medical care overseas somewhere.

(On top of these costs, it should be noted, insurance companies add a lot of unnecessary expense compared to other industrialized nations that provide direct access to medical care for their citizens.)

Of course, if American wages and salaries had grown along with the real cost of living increases and the productivity gains of the last forty years--instead of these trillions accruing almost solely to the wealthiest among us--then our buying power wouldn't be so diminished. We might actually be able to afford services provided by other Americans. The inequitable distribution of the productivity gains achieved by the American work force in the last four decades amounts to lost annual wages of about $20,000 a year for the average person.

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Massachusetts is currently holding hearings on the cost of care. There is a ton of material here for those interested. Given the similarities between the national reform plan and Massachusetts, it's worth paying attention to what's happening over there.

And the underlying diagnosis of inordinate health care costs must be addressed. Squeezing profit from sickness and sick people is not only wrong but inefficient and uneconomical. Health care providers make money from people being sick, not from keeping them well.

Don't stop short of connecting one dot further: The underlying reason for the cost-of-health-care crisis is the crappy food people eat, which is largely a result of the Farm Bill and other federal policy decisions around what to subsidize and what (not) to regulate.

And the further dot that is implied: industrial (fast) food outlets are clustered in low-income areas and their advertising is aimed past parents directly to childred via Ronald McDonald and all the rest. It's hard to see how the obesity and diabetes epidemics, especially among children, can be addressed without close regulation of this death-dealing industry.

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Single payer is the single answer. All else is excuse, obfuscation, or diversion.

Yes, health care cost inflation is a big problem, but it's not the primary driver of the deficit. Tax breaks for the wealthy and corporations are the real problem.

The Medicare trustees have been predicting insolvency since nearly the inception of the program. In 1990 Medicare was forecast to become bankrupt in 13 years. This year they're still estimating 13 years to insolvency. Over the years the cost inflation of Medicare has consistently been half that of private insurance.

In fact, if we do nothing but let the Bush tax cuts expire, CBO numbers show that the budget will come back into balance even if we don't "fix" Medicare and Medicaid.

And yes, the real fix for Medicare, Medicaid, and the ACA is a single payer that covers everyone. It works for the rest of the industrialized world far better than our dysfunctional mishmash of government funded and private, for profit, insurance.

http://www.patientphysiciancoop.com/benefits

We may have to take our health care problem by the horns and create patient physician co ops that provide tried and true basic health maintenance care. I am a physician in the Portland and Beaverton areas. I have personally witnessed unfair insurance practices to both the patient and physician. Eliminating middle man practices, to me, would solve a lot of the administrative costs. Health care must at the very least, do just that, maintain your health. Sick care doesn't help you. That simple paradigmatic shift would save massive amounts of health care dollars. Best, Dr. Huma Pierce