Economic theorists can easily make a case for why government should stay out of the health-care business, but they don’t have to deal with the realities (and we doubt they pay the full cost for their coverage). Simply put, society is not going to let uninsured people with health problems suffer without making some attempt to help them. That means third parties must pick up the costs.

We already do this, but denial lets us dress it up in the language of capitalism. The American way is to kick the costs down the road, rather than pay upfront, and it is irresponsible and self-defeating.

Take just two local examples that made recent headlines.

First, Spokane County Sheriff Mark Sterk announced a desire to build a pharmacy for the county jail to rein in costs for mentally ill inmates. Last month the county spent 10 times as much for medical care and prescriptions as it did for an average month in 1997. Why? Government merely shifted the costs for mental health from the front end to the back. Nobody thinks that the best place to address mental illness is a jail.

The second example is the news that only one in three Washington state dentists accepts Medicaid patients, because government reimbursements don’t cover the cost of care. Rather than address the problem upfront, government punted, hoping that enough dentists would donate their services. It hasn’t worked. An estimated 3.1 million Washingtonians go without basic dental care. Nobody thinks that the best place to address dental problems is an emergency room.

Low reimbursements are also haunting hospitals, clinics and private practices. Rising health insurance premiums are haunting employers, government and, increasingly, those lucky enough to be insured. Nobody is immune.

More than a decade ago, the federal government tried to ensure universal health care coverage and tame rising medical costs. The effort was shot down, but the problems persist. Senate Majority Leader Bill Frist, a Republican surgeon from Tennessee, recently gave a sobering speech about the state of health care in the United States. The National Coalition on Health Care echoed his sentiments in a report to Congress. They found that:

“ The number of Americans projected to be uninsured by 2006 is 51 million, up from 41 million in 2001.

“ The average annual premium for employer coverage for a family will approach $15,000 by 2006, which is double what it was in 2001.

“ Health-care costs are rising four times faster than wages and they easily top that of any other country.

A decade ago, the complaint was that health-care reform would intrude significantly on the economy. Today, health-care costs are implicated in layoffs and budget cuts, public and private.

We need a coordinated national strategy, and the longer we wait, the more it will cost.