President Obama will speak to the American people tonight on his health care plan. The talk is billed as his effort to reclaim the initiative in the struggle to improve health care in the USA.

There is one glaring ommission he should address. Obama and all others, myself included, have stated catagorically that the problem with our health system is that it is too expensive. Again, we pay more than twice what Western Europeans pay for the same standard of health care. The Obama team wants to control costs by encouraging competition among health care insurers, with a public insurer entering the game to set the standards.

I am a bit tired of beating up on the insurance companies as the cause of our runaway health care costs. It is akin to blaming the outrageous costs of getting your damaged car fixed by a auto body shop, you know, $1000 for a fender bender, on the insurance companies. The outrageous cost is what the car repairmen charge, the insurance company merely pays the bill.

What is missing from the President’s plan are real efforts to control costs. First, and foremost, would be to get some control over doctors’ fees. As I have stated before, the average annual income for a doctor in the USA is over $250,000 which is four times what a Swedish doctor friend of mine makes in his country. We have to control these fees. The only way to achieve this, is to have all payers resist, if not refuse, to pay these charges.

Perhaps having a public health insurance company would allow control on doctors’ fees. With the public company leading the charge, the private insurers could follow suit. However, this could lead to two health care systems, a low cost one, with a public insurer using fee controlled doctors, and a high cost one, with private insurers paying any fee asked by doctors. You would really be able to pay your money and take your choice.

Since I don’t really see any poltician ready to take on the doctors’ lobby, I suggest some other methods to cut the cost of doctors:

1. Allow Physican’s Assistants and Nurse Practioners to independently offer primary health care. These two highly trained and competent medical practioners earn about 25-35% of the average doctor’s income. This would allow competition between high cost and low cost service providers.

2. Allow medical services to advertise their prices, thus allowing true competiton. In the 1970s we broke the bans on lawyers advertising their prices to compete with each other. We should now break the bans on having medical services and practioners advertise their fees. The health insurance companies already do this, so we should extend this free competition to the ones setting the fees.

The only way to put an end to the rocketing cost of health care is to open it to genuine competiton. The health care providers will have to compete to gain business from individuals and/or their insurance plans. The insurance plans will have to compete to gain customers.