The legislature’s effort to reform health care and provide better access to Californians is admirable and necessary. But while lawmaker focus on new taxes to pay for insurance for everyone, none of the plans being considered address the real reason health care is sick: it’s outrageously expensive. Health care costs in California are skyrocketing and any health care reform that doesn’t address this fact is worse than worthless. It’s downright harmful.

Business owners were practically giddy this year when they found out their health insurance premiums would only go up by an average of 7.7% nationally and 8.7% on California. Why? Well, after health insurance rates had risen by as much as 15.8% per year in California each of the last few years, just slowing the increase feels like a rate cut. But it isn’t really a cut, and it still hurts. Employers used to cover their employees’ premiums completely. Now, unthinkably high rates have forced businesses to make employees pay ever-higher shares of these premiums. That is, of course, if the company hasn’t cut its health plans altogether—an increasingly common reality.

Please hear this and believe it: too many Californians lack health insurance for no other reason than because it’s too expensive. Small businesses can’t buy it for their employees, big businesses move out of state to keep from paying for it, and average families trying to get by just can’t afford it. Any attempt to increase the number of people insured without reigning in healthcare costs will just make this problem worse. Let me explain why.

Californians view healthcare as a right. It’s up there with the freedom of speech, the pursuit of happiness, and even eating and breathing. Californians want to be able to choose their own doctor, have convenient appointments, be tested with the latest diagnostic equipment, get a second opinion when the diagnosis is grave, receive the most advanced treatments, and take the latest and greatest drugs. And they want it all for free. I don’t blame them. I want that, too. I especially want it for my children. The problem is the free part. Modern healthcare is expensive.

And it’s getting ever more expensive. America is at the cutting edge of medical and pharmacological technology. There’s a reason people come here from Canada and the UK (where healthcare is free) to have heart surgery. But the research involved with those advances is extraordinarily costly—not to mention the liabilities associated with bringing new technology to market (they are essentially unlimited)!

Insurance does nothing to lower these costs. Quite the opposite, it increases them. When insurance is paying the bills, there is no incentive on the part of the doctor or the patient to control costs. When your life is at stake, money should be no object. But what about when you have the common cold? Should you really be taking the latest antibiotics that cost $10 per pill? (Viruses that cause colds are immune to antibiotics, but doctors often prescribe them because patients like to have some kind of treatment). In my own line of work, eye drops for allergies can cost anywhere from $6.00 to $75.00 for a 5 milliliter bottle. Antibiotics vary from $8.00 to $85.00 per bottle. If someone has a corneal ulcer (a sight-threatening condition) then I will prescribe the best. But if they have a run-of-the-mill bacterial conjunctivitis (a common, usually self-limiting condition), do I really need to break the bank? Having insurance pay for it makes it tough to say, “No,” to a patient with a red, painful eye staring at me in my chair. It also eliminates any incentive for patients to shop for doctors based on price.

So insurance companies drive up their premiums to maintain profits in the face of these rapidly increasing costs. If we put everyone on insurance (like the Democrats want), this situation is just going to get worse. That is, unless we do something to contain costs. So how do we do that?

There are a number of market-based reforms that people are beginning to advocate that can go a long way toward curtailing healthcare costs for individuals and employers.

High-deductible or “catastrophic” health insurance. Insurance plans that require the patient to pay the first $1,500 of medical costs per year cost hundreds less per month than no or low deductible plans. If you put some of these savings in a medical savings account or other tax-advantaged account then you are completely covered.

End “use-it-or-lose-it” status for medical Flexible Savings Accounts (FSA’s). FSA’s and similar “cafeteria plans” are special accounts in which you can save pre-tax dollars and spend them on medical costs. Right now, any money you don’t use in a given year is lost and they are only available through employers. Fix these problems.

Offer routine medical exams for free and/or with a tax credit. It is axiomatic in healthcare that the earlier a disease is detected, the less expensive it is to cure. Unfortunately, people often inadvertently let diseases go undetected for months or years. Letting people get a routine medical exam for free or giving them a $50 tax credit will encourage people to get checked. Insurance companies should even consider lower premiums for people who consistently stay on top of their routine care.

Increase costs for bad decisions. Right now, life insurance companies charge higher premiums for people who smoke, but health insurance companies only charge based on age. People should be charged more on monthly premiums or have higher deductibles if they make poor life choices or wait too long to seek care. This way, they may change unhealthy behaviors or, at least, shoulder a bigger burden for their personal decisions.

Train more primary care doctors and charge them less for schooling. We need to assign more residency slots at California’s five public medical schools to primary care physicians because they are in such short supply.

Many observers like to point to medical liability as being a driver of health care costs. While it is easy, and sometimes appropriate, to beat-up on trial lawyers, California's Medical Injury Compensation Reform Act (MICRA) has been very effective at holding down health care costs associated with abusive lawsuits. We should not increase the MICRA cap and we should prevent lawsuit abuse, just not in an effort aimed primarily at cost control in health care.

All of these measures will substantially lower healthcare costs, and none of them should really be controversial. We must try reasonable, market-based reforms like those outlined above before implementing the radical, economy-killing reforms the legislature is currently considering.

Universal healthcare has failed everywhere it’s been tried. One reason is that its implementation instantly and automatically eliminates the incentive for doctors and patients to control costs—so governments impose long, often life-threatening waits and cut back on treatment options. That’s not what Californians want or need. We deserve high-quality insurance that gets us the care we need when we need it. That has become difficult because health insurance is the fastest growing cost, by far, for California businesses and families. If we don’t address it, we won’t just be killing our economy, we’ll be killing ourselves.