The debate over health care reform in our country has been nothing if not entertaining. Each side has created an exaggerated cast of demons which they nobly oppose. Depending on your political leanings you probably find the demons of one side or the other to be the more real threats. Unfortunately neither side has decided to seriously target the one demon that we can all agree is real, but choose to ignore.

The left has selected big, for-profit insurance corporations as its demon, and with good reason. There are plenty of horror stories about denied coverage, pre-existing conditions (did we have them in the pre-existence as well?) and recision. The right has conjured imagery of death panels, Communism, and Adolf Hilter. More reasonable actors on the right use frightening terms such as Canada, and the UK, and occasionally tort reform.

The problem is that soon enough none of this will matter. That is because the growth rate of our country’s medical bills is four times that our any other expense, and that combined with the coming retirement of the baby boomers is going to sink us as Medicare expenses soar.

Of course almost nobody is willing to touch this issue with a ten foot pool because of the twin facts that Medicare is a very popular program and old people vote and they love the status quo.

The sad thing is that the status quo isn’t all that great for anybody, and its incentives are all screwed up. Doctors are not paid to make you healthy. They are paid to perform services. You hope that this makes you healthy, but they get paid either way. In a perfect world this wouldn’t matter because doctors would all be noble and patients would take the utmost responsibility for their own health, but this isn’t a perfect world. Anyone who is paid to perform certain actions and not others is going to tend towards performing the incentivized actions. You can’t help it. So clearly what we need to do is shift publicly funded health programs towards a model in which doctors are paid for making their patients healthy rather than performing procedures on them. We should probably give the patients some direct financial incentives as well, since it seems obvious that many Americans will not take needed measures simply for the sake of their own health.

If Medicare and Medicaid showed some leadership and came up with a compensation model that worked it could then make its way into private insurance as well, potentially lowering costs for everyone while yielding better outcomes.

Of course nobody is discussing this because the Democrats have decided to make insurance companies the enemy and the Republicans, remembering the lessons of 93 and 94, are interested in stopping anything and everything at all costs in the interest of their own political gain.

Personally I think many of the insurance centered reforms being proposed now are good ideas, but do not address the problem of escalating costs that will be born by taxpayers. This is sad, because as has been noted by all sides, the opportunity for health care reform comes up very rarely. We aren’t going to have many more shots at this before it bankrupts us, and both sides are spending an awful lot of political capital on what is not the core problem.