The debate about health care reform is under way in the United States. Everybody has ideas about what to do, but few understand how we arrived in our current predicament.

In order to create progressive policy, we need to look at the past. In many regards, our current problems are rooted in the mid-1940s and World War II.

The 1940s saw the introduction of penicillin into the practice of medicine.

The use of this antibiotic was pivotal in the sense that it changed patient prognosis and enabled recovery from disease states that were previously fatal.

This simple, clinical application changed demand for medical services. It enabled the development of surgical procedures that substantially improved a patient's quality of life. Prior to this time, some argue that the demand for medical care was only moderate, as it often failed to produce substantial long-term benefit.

During this same period of time, the United States was engaged in World War II. In an attempt to control wartime inflation, the FDR administration implemented price and salary controls. Salary restrictions forced companies to find imaginative ways of enticing and keeping employees.

Enter the age of health insurance. In order to attract workers, and to not violate salary freezes, companies started offering employees "free" medical insurance. This insurance was a non-taxable benefit to the employee, and a tax deduction to the businesses.

Though it was Harry Truman who made the formal call for a national health plan in 1945, by the time salary and price freezes were lifted, most workers had private health care benefits. This left one largely uninsured group -- the elderly. In 1965, Lyndon Johnson signed into law the "new" Medicare/Medicaid programs. As a result, the vast majority of society had access to quality health care with little to no out-of-pocket expense.

Since the 1950s, the cost of delivering health care has steadily outpaced the growth of the economy and general inflation. There are multiple factors involved here; technology (MRIs, CT Scans, etc) is constantly evolving, people are living longer and frivolous lawsuits are just a few of the cost pressures.

Perhaps the most significant inflationary pressure comes from the demand for high quality health care -- for free. Yes, for decades, health insurance has largely shielded the consumer (the patient) from the true cost of delivering quality.

The direct result of "free" health care is naturally over-consumption, which inherently boosts the cost of health insurance. Therefore, if we are to hope to deliver high quality health care for an affordable price, we must displace more cost to the consumers.

As a physician, I'm witness to this fact on a daily basis. Many patients will complain nonstop about a $20 office visit co-pay, but they don't think twice about taking their spouse to the movies. Often, these same people will insist on heroic measures for their sick elderly parents, only to postpone the inevitable.

If the consumer had to bear more of these costs, the benefits to society would be billions of dollars annually.

One final note. Medical expenses should not push people to the brink of bankruptcy. However, people must treat medical care like something of dear importance. By expecting the consumer to pay more, we will ultimately create more affordable health care. One of the keys to addressing the cost of health care is understanding the importance of responsible utilization.

Dr. Gary Gonsalves is a North County anesthesiologist and co-founder of Stop Taxing Us. Contact him at www.StopTaxingUs.com.