Health care costs are just part of a larger, bleak picture painted by Walker, who said that the gross debt per person is about $25,000 — about four times the current annual gross domestic product. GAO analysis indicates balancing the budget in 2040 could require actions as large as "cutting total federal spending as much as 60 percent or raising federal taxes up to 2.5 times today's levels," he said. Closing the long-term fiscal gap based on reasonable assumptions would require "real average annual economic growth in the double-digit range every year for the next 75 years," deemed unlikely.

The implications of rising health care costs include increased government spending, more pressure on U.S. companies, a bigger financial burden for families and increased cost for providers, Walker said. They may also slow work-force growth, lead to more work sent overseas, loss of full-time in favor of part-time jobs, slow wage growth, reduced retiree benefits and slow revenue growth from individual income taxes and payrolls.

Walker called for incentives for both providers and consumers to be prudent about health care choices, for transparency about the value and cost of care options and for accountability from health plans and providers to ensure appropriate use and quality.

He told panel members to consider their own Hippocratic oath to "do no harm. Don't dig the hole deeper," he said.

Other speakers addressed the benefits of integrated information technology systems and the importance of more patient-centered care, where patients understand their options and make decisions.

Dr. John E. Wennberg of Dartmouth Medical School has created models that prove informed patients get better outcomes and save health care dollars. He's leading efforts to create "decision aids" to promote that.

He said savings would result from eliminating underuse of effective care, reducing medical mistakes and using outcomes research to learn what works, then doing it.

According to Dr. Stanley Huff, an informaticist with Intermountain Health Care, and Dr. Scott Williams of HealthInsight, technology well used improves outcomes dramatically while reducing costs. The savings nationwide from integrated systems including electronic medical records and best-practice computer programs would be billions of dollars nationally, they said.

Hatch closed the hearing with words of encouragement for the panel, which has a huge task of gathering information on the entire health care system, then making recommendations, scheduling a series of town meetings that would include each state and providing a report to the president and Congress, all in the space of about a year.

"I believe what you're doing is one of the most important opportunities of anybody in the history of the country," he said. He warned them to pay attention to the political background against which they work, but to ignore the politicians and do what's right for all citizens.

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E-mail: lois@desnews.com