PRESIDENT BUSH has identified a leading cause for rising health care costs, and it is us.
As consumers of medical services, we're not good shoppers, the president said last week. The 85 percent of Americans who have health insurance are particularly to blame, Mr. Bush argues. They pay a premium - usually subsidized by employers - then "just show up and collect the benefits. There's no demand for better prices."
He's got a point: Smarter shopping for health care services, especially prescription drugs, would help bring medical costs under control. But his proposal to effectively put the burden of negotiating medical fees on individual consumers is so impractical it amounts to a hoax. (Patient to heart surgeon: "Is that your best price?")
The unmistakable agenda of the Medicare bill Mr. Bush signed last year and his new health care access proposals is not controlling costs but shifting them from employers and wealthy taxpayers to individuals who can least afford them.
Look at the 10-year cost of the Medicare expansions now estimated by the White House to be $134 billion - or one-third - higher than congressional number-crunchers said last fall. Mr. Bush's budget team was more realistic in projecting the cost of pharmaceuticals and subsidies to private health care plans.
No smart shopping involved there: The new law specifically prohibits the federal government from using its massive buying power to negotiate with drug companies and pays bonuses to private health plans for taking on Medicare patients.
But there's a fail-safe. When the exploding growth of drug and middleman costs finally drives Medicare to insolvency, Congress will be required to cut payments to doctors and hospitals, trim benefits or raise payroll taxes, which hit low-income workers hardest.
That's cost shifting, not cost cutting.
Mr. Bush is running for re-election on a platform that trumpets his success at providing prescription drug coverage for older Americans. Yet his legislation not only undermines Medicare but encourages employers to drop private retiree coverage as well.
Democratic challengers propose to increase access to health care mostly by expanding government programs and raising taxes on the wealthy to pay for them. They generally avoid the trickier challenge of ensuring that health care dollars are wisely spent.
That's not good enough, either. Some combination of individual and government restraint will be required. With a health care system that squeezes doctors but not drug companies and allows some users too much and others too little, don't believe anyone who says fixing it is going to be easy.