How ready is America for the grown-up debate we need on health costs? Not very!

Consider GE, where workers went on strike this week because the company dared to raise employee contributions to the health plan by anywhere from 50 cents to a dollar a day. This $200 to $400 annual increase came after GE’s overall health-care bill rose $2,300 per employee, or 45 percent, in the last three years.

On my calculator that means GE absorbed 85 to 90 percent of an extraordinary cost increase. Yet union politics required leaders to call a strike over what in context seems a modest boost in cost-sharing. Meanwhile, government at all levels continues to subsidize such employer-provided coverage (in ways most people don’t realize) to the tune of $125 billion a year – while offering nothing to the 40 million uninsured.

But this is only one surreal scene in the evolving health-cost drama. Ten states, reeling from budget crises brought on partly by spiraling Medicaid costs, are forming a purchasing group to bargain for lower drug prices from manufacturers.

A new federal report shows that health spending now tops 14 percent of GDP – a record – while other rich nations devote just 9 or 10 percent of national income to health care, while insuring everyone and enjoying longer lifespans and lower infant mortality rates. Doctors, meanwhile, are screaming that Medicare’s reimbursement rates are so low they can’t cover their own rising costs. Yet we also know U.S. doctors earn far more than their counterparts internationally.

Clearly something’s out of kilter. But here’s the problem. Everyone says they want to control health costs. But what nearly everyone really means is that they want to shift their health costs to somebody else. In the maddeningly complex world of health care, this difference – between cost shifting and true cost effectiveness in health-care delivery – is the best way to follow what’s going on, and the only way to know what it will sound like when we finally get serious.

Business, for example, says health costs are out of control – but one of their major coping strategies is to support a new prescription drug benefit in Medicare. That’s because if the feds pick up the tab for these drugs, it will get business off the hook for billions they’re now expected to pay for their retirees. It’s perfectly rational, but it’s also a cost shift.

To employees, cost control means employers picking up the tab, and not passing it on to them. To state governments, cost control means getting the feds to pay more of the bill. To the federal government, cost control means such ideas as making Medicare a program through which the feds make a defined contribution to help recipients buy private coverage, thus taking taxpayers off the hook for the full extent of future increases in medical bills.

All of these efforts are understandable. But all of them involve cost shifts. And in the end, cost shifts aren’t about solving the problem; they’re about making health costs somebody else’s problem – a situation that will always favor those with more raw political muscle.

True cost effectiveness in health care requires a new kind of national conversation – and it can’t start soon enough. Health costs are slated to soar from today’s 14 percent of GDP toward 20 percent once the baby boomers start to retire in a few years. Finding ways to slow this growth in ways that actually improve health outcomes is a national imperative if government is to have money available for any other purposes.

The good news is that this is doable. There are models out there, but that’s grist for another day. The important thing that has to change first is our mindset. We can’t keep pushing costs to the other guy. We need to re-engineer health delivery in ways that cut costs while improving quality. It won’t be easy, because every dollar of health care “waste” is somebody’s dollar of income. But until we start thinking clearly about our goals, we’re just playing make-believe.

Matt Miller is a syndicated columnist. His e-mail address is: [email protected].