It's not because we're inefficient.

Despite what others may say, it's not because we provide poor care and have high infant mortality.

It's not because we don't emphasize preventative care.

And believe it or not, it's not because most doctors are greedy and overtest for profit.

Oh sure, there are stories like this, where pre-terminal care lends itself to over-consulting and over-testing, in part because patients and their families have little financial stake in the game and, in part, because of the looming malpractice concerns for physicians. While important, the reality is that these concerns represent a mere 29 cents of the health care dollar.

And yes, there are the intermediaries: the insurers, the coding and compliance officers, the medical device companies and the pharmaceutical companies getting their piece.

But these patient care issues are minor weather disturbances compared to the health care cost jet stream that rises above all others: politics and the need for jobs.

Health care, after all, has become our economy.

If there is any question about this, look to down-state Illinois in the city of Springfield that serves as the capital of our president's home state. Look to city that has two main acute care hospitals, some of whom have entire wards that stand empty, feverishly competing with each other. Look for the new SimmonsCooper cancer care center, built on the backs of a wink and a nod to contractors and state regulators, yet remains shuttered.

Yet this does not thwart the director of this center. No, in his Spring newsletter he criticises the lack of coordination he observed in cancer care on a junket to King Hussein Royal Military Hospital in Amman, Jordan, while not even acknowledging that his own care center remains closed. He concludes:

"Let's hope that our efforts to educate our state government representatives on how we are helping to lessen the terrible burden of cancer in downstate Illinois will convince them to provide the necessary funding to occupy our new center this coming summer."

Earmarks. Waste. Inside deals. Hidden spending.

How do we make this part of health care reform?

-WesMusings of a cardiologist and cardiac electrophysiologist.