Among the many possible explanations for a $500 million increase in annual claims expenses for Regence BlueCross Blue Shield of Utah over the past 10 years, the one offered by CEO Scott Ideson is most unlikely. Inflation and age adjustments will likely substantially shrink the apparent growth of claims expense in his figures. Contrary to Ideson's assurances, 8 percent administrative expense is substantially higher than necessary and must be multiplied by the mirror image effect that benefit denial bureaucracy has on providers of health care: They must staff up just to fight the paperwork war that has become American health-care financing. In the calendar year 2000, Americans paid $2,400 per person more than Canadians for health care; $1,600 or two-thirds of that difference was due to higher administrative costs in the United States.

But Ideson would have it that American patients are at fault for rapidly rising health-care costs. He insists that we are insulated from the true cost of care and therefore are demanding and getting more health services than necessary. The facts are otherwise. Americans neither see physicians nor use hospital beds on a per capita basis more than citizens in other first world nations. We have no more MRI scanners than do our fellow world class citizens. First dollar coverage is more common in other developed nations, where point-of-service payments, deductibles and co-payments are less often employed. The overwhelming majority of health-care expenses are paid out for catastrophic problems: major surgeries, chemotherapy, intensive care, etc. Patients do not seek that kind of care simply because the price seems low. Do you know anyone who has had open heart surgery (or even an appendectomy) simply because it was cheap?

If Ideson's data about increasing medical claims cost is useful at all, it should be used to underscore the fact that he and other health insurance executives have totally failed to translate the immense resources generously given by the American people to health care ($2 trillion this year) into access and financial support for medically necessary services for all U.S. citizens. In truth, the health-insurance industry has no incentive to slow the growth of health costs. If Ideson is correct when claiming a 1 percent profit each of the past 10 years, that would allow for approximately $6 million more in profits this year than a decade ago. How much more does the CEO of BC-BS make now than then?

Rising costs in health care should not be blamed on patients. They are primarily the result of inefficiencies in American health-financing systems, including health insurance and managed care. The current trend in health-care financing, euphemistically called consumer-driven health plans, will succeed in displacing risk for health expenses onto the sick while failing to contain costs, increase access or support quality in American health care. Since health-insurance companies now neither want to accept responsibility for risk nor pay for needed health care in a reasonable and timely manner, I think it is time that we recognize that they are the source of our biggest problems in health care and therefore can not be part of the solution.

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Joseph Q. Jarvis is President of Utah Health Alliance in Salt Lake City.