The Wenatchee World, Wash., Tracy Warner column [The Wenatchee World, Wash.]

Dec. 17--From the beginning of this tortured reform effort, it was clear the basic economic design of the American health care system is horribly flawed. It is loaded with incentives to provide more health care without regard to cost or effect, so we pay, and pay, more and more for health care that is not always better, and sometimes worse. And these runaway costs and perverse incentives are the root of the system's other celebrated flaws -- the rise of the uninsured, business struggles, stagnant wages, heartless insurance companies, the sick uncared for or made destitute, governments buried in the expense. Health care costs still rise at twice the rate of inflation. The cost of an average family insurance plan has doubled in a decade and now is pushing $14,000 a year. The price government pays for health care, roughly half the national total, has doubled in a like manner. Health care now consumes 18 percent of all the wealth the nation can produce, nearly twice what other industrial nations pay, and the share is rising with no end in sight

So there is the essential reason health care reform is of critical importance. And what do the health care reform bills now pending in Congress do about this? Almost nothing, according to most analysis. The same fee-for-service system, with doctors and institutions paid for quantity rather than success, where insured consumers use health care without regard to cost, the same system with all its destructive incentives, will not just remain intact but be expanded. The cost-control measures in the legislation are puny -- pilot programs, experiments, boards of experts to offer advice. It's all on the periphery. There will be no impact soon, and the ultimate benefit is doubtful.

In the health care bills now pending the primary method of reducing the ranks of the uninsured is to force them to buy into an unreformed, costly system, most to be subsidized by taxpayers. Some of the cruelty of insurance will go away -- no one can be turned away for a pre-existing condition, no policies canceled because of ill health, etc. That may be good to boast about, but it has a price. The projections are, everyone will pay more.

"The way things stand now, if you get health insurance through work, as 83 percent of all privately insured Americans do, your premiums are expected to go up by about 5 1/2 percent each year through 2015," wrote Sen. John Thune, R-S.D., in RealClearPolitics.com. "Premiums for a typical family in that situation run close to $14,000 a year now, with employers paying the lion's share. That number will jump to about $20,000 a year by 2016 under the Democrats' so-called reform plan." Expect smaller paychecks, he said, and fewer jobs created.

Progressives prefer different means to cuts costs, but have no higher expectations of the pending bills. "If I were a senator, I would not vote for the current health-care bill," wrote former Democratic Chairman Howard Dean in The Washington Post. "Any measure that expands private insurers' monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform. ... Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these." Wrote Markos Moulitsas of DailyKos: "My take is that it's unconscionable to force people to buy a product from a private insurer that enjoys sanctioned monopoly status. It'd be like forcing everyone to attend baseball games, but instead of watching the Yankees, they were forced to watch the Kansas City Royals."

Health care reform is still very necessary, but we aren't going to get much of it. Instead, we'll get a more expensive, compulsory version of the unreformed system. It's time to start over.

Tracy Warner's column appears Tuesday through Friday. He can be reached at warner@wenworld.com or 665-1163.

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