Are Maine hospital CEOs paid too much? You could certainly make that case about Richard Willett at Redington-Fairview, who earned $693,000 in 2009 and $550,000 a year later, according to a Sun Journal report last Sunday. That’s more than twice as much as his peers in other small acute care hospitals.

But there are other outliers as well. A surgeon at Blue Hill Hospital, one of the state’s smallest, earned $489,000 in 2010, more than twice as much as that hospital’s CEO.

Such salaries get reactions from the public ranging from outrage to a shrug. But we shouldn’t fool ourselves. The real, almost overwhelming, problem is not any particular person’s salary, but the inordinately high costs of our state and national health care systems.

Compared to the average of 30 other leading industrialized nations, the United States now spends, per person, twice as much on health care, and 50 percent more than any other single nation. Most of this gap has opened up over the last 40 years. We’ve been asleep at the switch during what is now truly a national crisis.

The difference between us and them? Everyone else has a unified system. We do not.

Most policymakers, of course, know about our costs, and there have been dozens of prescriptions for a cure. Consumer advocates emphasize that nearly 20 percent of Americans have no health insurance, public or private. Business analysts point out that we reimburse providers through a kaleidoscope of different rates, almost none of them related to good health outcomes. Primary care physicians, still in short supply, point out that offering initial access to health care through hospital emergency rooms doesn’t make us healthier, and does make us poorer. And we can all agree that our insanely complex billing system adds enormous additional costs.

Yet even if we somehow managed to implement reforms dealing with all these problems, we’d still be stuck with an expensive system. Top-flight health care professionals here are simply paid far more than anywhere else.

The Affordable Care Act (“Obamacare,” to its detractors) attempts to deal with the access problem by offering insurance to 30 million more Americans. It also makes a stab at controlling costs, though that is definitely still a work in progress.

Still, it at least tries to address the system’s many problems. Anyone joining the federal lawsuit now before the U.S. Supreme Court, which claims that the Affordable Care Act is unconstitutional (and that includes Maine’s governor and attorney general), has a duty to say how they would deal with the crushing burden of health care costs. And it has to be a plausible answer, not just a theory about the private individual insurance market or a proposal to reduce Medicaid enrollments and create more uninsured Mainers.

Given the stakes, it’s unacceptable not to have a plan.

Douglas Rooks is a former daily and weekly newspaper editor who has covered the State House for 25 years. He may be reached at [email protected].