Americans are now bored with the health care debate. Our infamous short attention span is about to get us into big trouble, as voters zone out during the final push to get a bill through Congress. The looming legislation will upend a sizeable portion of our economy and without a doubt add to our nation’s fiscal woes. This is not the time to switch channels, even for the Yankees.

The most recent horror is the sleight of hand being conjured up Senate Majority Leader Harry Reid. He wants to introduce a new, separate, bill which will postpone the cuts in doctors’ pay which are included in the health care bill. He knows full well that if you slice 21% off the fees that doctors can charge, fewer Medicare patients will be treated. In other words, Reid wants to hand President Obama a bill that abides by his “no increase in the federal deficit” pledge, even though the claim is completely dishonest. This bit of fiddling goes beyond the normal cynical manipulations of Congress; will Americans put up with this chicanery? Only if they are not paying attention.

The bottom line is that there is no way – there never has been the most remote possibility – that we can provide health care to tens of millions of Americans without it costing taxpayers money. If we could, it would have been done a long time ago. Remember that the administration initially promised not only to include all Americans under the medical tent, but also to lower the rising costs of health care. Sadly, that latter goal has been completely abandoned – no one is even pretending that we are going to lower the trajectory of medical costs, because it simply isn’t going to happen.

This entire debate has left out four items essential to lowering the cost of health care:

- First, there is nothing in these thousands of pages that pushes Americans to be more responsible about their own health. There are no rewards for quitting smoking, or getting on the treadmill, or getting a flu shot. That is a huge miss. 

- Second, there is no attempt to rein in malpractice costs. Putting a lid on awards is not hard. though it may well be impossible given the vast amount of money that flows through the malpractice shops into Democratic coffers. Estimates vary, but many reports say that fear of lawsuits prompt some 20% or so of medical expenses for unnecessary procedures and tests. 

- Third, I am not aware of any effort to cut through the regulatory impasse and allow insurers to compete across state lines. The consequence of the status quo is near-monopolies enjoyed by insurers in most states; what is the point of that? There is some talk about removing the insurance industry’s exemption from anti-trust enforcement. Why not address the problem directly? 

- Fourth, there is little change in the basic model of reimbursements. Doctors get paid by the government according to formulas that encourage waste. For instance, in some cases doctors will prescribe only one month of medication so that the patient must return frequently, ringing up unnecessary monthly office visits. Hey, if you got paid by the visit, you’d prescribe only a one month dose too.

Just because it has gone on too long doesn’t mean this bill is good for America. Just because we have been struck nearly unconscious by the endless haranguing from President Obama does not mean that we should give up. And, just because the Obama administration jumps on anyone who takes issue with this push, doesn’t mean we should roll over. This is too important.

Liz Peek is a financial columnist and frequent Fox Forum contributor.