• Editor's note: This is the first in a series of Tracy Press editorials dealing with health care.

The cost of health care is bankrupting this country.

Each year, millions of Americans claim bankruptcy because of medical expenses. Millions more teeter on the brink and cannot afford adequate health care. Many who have insurance are denied life-saving medicine by an industry pressured by its bottom line to keep spiraling costs down.

Businesses live within a straightjacket of providing medical insurance for their employees. Government — brought to you by Joe Taxpayer — spends billions on medical care.

The raw numbers are staggering.

All told, health care accounts for 17 percent of the domestic economy. That’s an estimated $2.5 trillion in 2009 — or nearly the entire gross domestic product of the United Kingdom.

In just nine more years, that figure is expected to jump to $4.4 trillion. And, whether it’s through increased insurance costs, a decrease in take-home pay, higher taxes or declining health, you will pay for it.

Unless something is done to brake this inflation, virtually no one will be able to afford health care within our lifetimes.

This is why any health care reform bill that passes the desk of President Obama must, at its core, be focused on containing costs. Because while there is a moral imperative to provide everyone in the richest country on Earth with adequate health care, there is an equally strong imperative to not let medical costs send families and the country toward insolvency.

But for various reasons, very few have been willing to talk honestly about controlling health care costs, even though it is vitally important to any systemic reform.

For starters, we need to admit where increased costs are coming from.

A major contributor is an aging population riddled with chronic ailments such as obesity, diabetes and cardiovascular disease — the Centers for Disease Control and Prevention estimates that treatment of chronic diseases accounts for more than 75 percent of national health expenditures.

Patient behavior is another. As more expensive technology and medicines are introduced, patients want the biggest and the best — even if there is no proof the new procedures or drugs offer any significant advantage over their cheaper, more traditional or generic counterparts.

Furthermore, too few patients have the incentive to avoid expensive procedures, since if they are insured, the insurer is the one who will likely pay the bulk of the cost. This moral hazard is a major driver of expanding health care costs.

Then there are doctors. While doctors’ primary focus is treating patients, they, like patients, do not bear the cost of expensive or unnecessary procedures. Plus, the existing a la carte payment system reimburses doctors based on what procedures they perform and on a per-visit basis, not based on outcomes.

Insurance company profits and administrative costs also make medical care more expensive. But government reimbursement plans that do not pay for the full cost of treatment, forcing hospitals and doctors to charge more to those covered through private and employer-based insurance, are also a culprit.

Legal costs and defensive medicine play a part, too. Though only a fraction of overall health care costs, malpractice insurance and the unnecessary procedures doctors prescribe to guard against lawsuits account for money wasted.

There is always the specter of inefficiency — whether in hard-to-access patient records or a lack of local competition in insurance markets — that drives up costs.

And then there is the way we treat insurance itself. What was first thought of as a risk-management system is now expected to pay for everyday medical expenses, ensuring that those who have insurance coverage often never know the true cost of getting health care and giving patients little reason to avoid expensive or unnecessary treatments.

Though it’s quite a list, the situation isn’t hopeless. For the first time in memory, all major stakeholders — patients, doctors, insurance companies, politicians — agree that there must be change.

But what kind of change? What could possibly be done to improve health care across the board while also containing costs? We’ll deal with that in an upcoming Our Voice.