Almost everyone agrees that more should be done to hold down health care costs. But can it be done without jeopardizing the quality of health care Americans have come to expect? In some ways, the future of American medical care has never looked better. Doctors are routinely performing surgery that would have been unthinkable 20 years ago. Organ transplants, open heart surgery and other sophisticated procedures have saved lives today that would have been lost many years ago.

But these medical breakthroughs carry a price tag--and a very large one at that. Open heart surgery can cost $25,000 to $40,000, a liver transplant is $140,000. Through the 1980s, medical bills have continue to rise faster than the rate of inflation. In the past years, medical care costs have risen 6.6 percent, compared with a general inflation rate of 3.6 percent.

Most health care experts say Americans should be able to set up a cost effective health care system without making severe sacrifices. We have enough doctors and hospital beds in this country to treat everybody. We have the resources but we can't seem to find the method of organization and moral rules that will allow us to divide it up in a sensible way.

If Americans cannot agree on a rational method for allocating health care and cannot afford to pay the rising bill, they may be forced into the rationing of health care anyway. Most insurance companies and government officials shy away from rationing. Private the public insurers talk instead of inducing doctors to provide health care with a closer eye to the expected costs and benefits. Already an infant industry is developing computer software program that show which medical procedures fail a cost benefit test. Such software will be marketed to employers and insurance companies to help them keep a lid on medical claims. Advocates of this approach argue that the American bias toward expensive surgery has exposed patients to unnecessary risks, resulting in needless deaths. Skeptics worry, however, that such institutionalized cost-consciousness might proceed at the expense of patients' best interests.

The most important indication of the danger that lies ahead is the growing share of the nation's income that medical costs are claiming. For example, General Motors Corporation spent more than $2 billion on medical care coverage for its employees; over the same period, the auto-maker posted profits of $2.7 billion. The cost of employes health insurance is usually passed on to the consumers in the form of higher prices for American goods and services. This really hurts the competitiveness of American products because companies have to spend much more on employees for health benefits, causing prices to go up. There are 37 million Americans uninsured for health care. Our inability to organize a universal system for insurance to manage health care for these millions is a bad social and economic policy.

The government and labor leaders who came up with this system had planned it to be universal by working on the flaws as they go. The employment-based tax incentive, health insurance would cover all American workers. The taxpayer-financed Medicare and Medicaid programs were made to fill the open areas left at either end for the poor and the elderly.

However, this "patchwork" system just isn't working. While more families are living below the poverty level, Medicaid enrollment continues to drop. Fewer workers have health insurance as more people work in smaller, service businesses.

Since Americans pay the health care tab for Americans on way or another, why not pay the bill head on, fairly and efficiently, through universal health insurance? Universal access to health insurance is likely to continue the public-private partnership that has been built over the past 50 years. All employes, regardless of health status, should be guaranteed basic health benefits for themselves and their dependents. For those outside the work force, Medicaid coverage should be made universally available, with appropriate subsidies for the poor. The over 65 population should continue on Medicare benefits, which should be further expanded to eliminate all costs to individuals for catastrophic care.

Who will foot the bill? I believe that universal access will result in the redisribution of existing costs. Employers who don't provide health insurance will lose their free ride on the coattails of those who do. Small and start-up businesses can be assisted through tax incentives and legislatively mandated insurance groups that extend efficiencies now available only to big groups. The government will regroup some of its revenue losses by moving a segment of the population out of the publicly financed health care system into the private insurance area.

The least efficient move is to clos the doors of the system to those who can't afford insurance. The smarter move is to put all Americans into insurance systems that are designed to assure appropriate quality care and contain costs in a systematic order. Without an organized insurance program, we don't know when, where and why care is delivered and there is no way to manage health care costs.

Another problem that faces Americans is the elderly. The American population is rapidly getting older. In 2011, the first of the baby boom generation turns 65. By 2030, at least one in five Americans will be elderly and their grandchildren as well.

What it means to be old in America is a matter of great importance, because the elderly here at the present time are not only a population that is greater than all of Canada's but a rapidly growing share of the total U.S. population. At the turn of the century, only 4 percent of Americans were 65 or older. By 1950, that percentage had doubled, and by 1986 it had tripled. Since the proportion of young people has been declining, the whole American population is "aging." This is a trend that will have a great impact on the American Society.

As the four generation family becomes commonplace in the next century, men and women will face the concern and expense of caring for their very old parents. More adult workers will be faced with the care of very old, and frail parents, and employers will have to deal with workers wanting time of the deal with the situation. The proportion of institutionalized elderly may well grow. With the great cost of health care no one will be able to afford it. Nursing homes for the elderly are outrageously expensive. With the great cost of nursing care for the elderly, people will not be able to afford it, therefore, making them live off the state causing it to come of the taxpayers' pocket.

The question we all have to decide is whether the solution is worse than the problem. We all know that something has to be done. We have got to put a limit on hospitals and what they charge for health care. It is time for Americans to face this serious problem. How are we to pay for long-term case for the disabled elderly and to afford insurance for Americans today? Americans are more interested in receiving the best health care that is available. They are not interested in the most cost effective.

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