While just about everyone involved in health/medical care agrees that our system is too costly and we are not always getting the best of care for what we spend, the efforts to rein in these costs and reform the system are all wrong. The efforts are all directed at price controls from the top down and do not address the causes of the rapid rise in costs.

First, we must clarify whose costs we are talking about: the costs to those who are paying the bills (patients and insurers) or the costs to those who are providing the care (facilities, doctors, therapists, etc.). The costs incurred in providing care are passed on to those receiving the care. This is no different than any other product or service we buy. If the costs of rubber and steel go up for Ford, the prices of Ford cars go up to pay for it. The same applies in any product or service industry. You either meet your costs and make a profit or you go out of business.

Government's approach to health care financing is nothing more than top down price controls. Pay the facilities and providers less and let them figure out how to reduce their costs of staying in business. This backward push can go only so far though improved efficiencies before the services themselves are reduced, restricted or become unavailable.

This is seen as medical offices restrict the percentage of Medicare and Medicaid patients they will accept because those payers commonly pay less than it costs to provide the service.

If we are to get a handle on health care costs in this country, we must address the prime drivers of health care costs: 1) a rapidly growing and aging population that expects availability of the newest and best in medical care; 2) technological advances that make more effective care possible for older and sicker patients as well as new treatments we have never had before; 3) an entitlement culture that is slowly but surely stripping us of our sense of personal responsibility; and 4) a legal system that feeds and encourages No. 3.

Several employers in Nebraska have shown us how to reduce health care costs. These employers have instituted wellness programs that create incentives for employees to take control of their lives and to take responsibility for their own health. The results have been a healthier workforce and lower total costs for the employers and the workers. Reductions in costs have ranged from 24 percent to 33 percent, as reported in the Omaha World-Herald and Lincoln Journal Star. It has not required any new government spending, taxation, federal programs or bureaucracies.

Nor does it allow the power-hungry in Washington to take over more control of our lives.

Such changes certainly are not the whole answer. Insurance practices will need reform or increased regulation. And the issue of caring for those disadvantaged and in no position to provide for their own care will need help. This country has always done that and always will.

But even within the Medicaid ranks, incentives need to be introduced. States that have instituted minimal ($1-$2) co-pays for emergency room visits have seen a reduction in inappropriate use of emergency departments. It is ludicrous to go to an emergency room to get a prescription for an over-the-counter drug such as aspirin so it can be obtained for free.

All health care will be paid for through out-of-pocket expenses, taxes and charity. The only money the government has it takes from us as taxes, prints or borrows. The payers are always and ultimately the people.

Those who seek and receive the care and then pay the bills should be the ones who determine what care is received and how it will be paid for. More personal responsibility and self-determination will go a lot farther than more government intervention in solving this country's health care problem. The more we depend on government, the more freedom we give up.

Charles Gregorius, M.D., is an anesthesiologist who practices at BryanLGH Medical Center.