The most effective way to control health care costs without moving into a totalitarian, politically-controlled monopoly, is to begin moving back to a model where costs and users have some connection again.

Some ideas off the top of my head:

--Start allowing more competitive options in health insurance, with fewer mandates and more freedom to purchase policies across state borders. Increase the private choices people have. The goal is to start moving health insurance back to where it used to be: something for emergencies. I remember when it used to be called "hospitalization insurance." For everything else, my parents wrote checks.

--Put personally-purchased insurance on an equal tax footing with employer-provided insurance. Of course, the way some people would do that is to lay a tax on employer insurance. I'd rather see personal health insurance expenses become deductible for the average citizen (it is for self-employed people).

--Health savings accounts are a good idea.

--Try to reduce the barriers to health care providers and technologies entering the field. Ease some (not all) regulations on non-traditional care and prevention methods. The current medical profession is almost a guild, and organizations like the FDA are almost psychotic in their caution. Certainly there should be some rules and regulations, but I think they're a lot stiffer than they have to be. Focus on safety, maybe, and let people make more choices on effectiveness.

The key is to increase competition, and allow enough costs to filter through to the end user to instill market forces again. The reason costs are rising so drastically is that there is no reason for them not to. Hospitals charge ten bucks for a pill because somebody will pay that much.

Some of these things could be done immediately. Some need to be phased in over time.

But none of this will happen. There's no political power to be had in any of it.