My father-in-law was rummaging through old papers awhile back when he came across itemized hospital bills from his own birth in 1934.

Nothing puts the current health-care debate in perspective quite like a trip in the way-back machine — in this case to the Portland Sanitarium and Hospital in Depression-era Oregon.

And nothing focuses the problem quite like a glance at an old hospital bill.

My father-in-law's mother had severe complications. She ended up staying in the hospital 16½ days. Doctors told her she would die. (In fairness to them, she did ... 72 years later.)

The cost for all of this? Board, room and general care: $5 per day. Use of the operating room: $7.50. Treatments, medicines and laboratory fees ranged from $2 to $4.80. The grand total for 16½ days: $173.60.

I used a simple inflation calculator, (found at to determine the bill would be the equivalent of $2,763.59 in 2008 dollars.

Perhaps that's not the kind of money young couples have lying around the house, but I'm guessing it's much less than a similar hospital stay would cost today. You could reasonably afford it, or find a way to get the money without too much trouble if you didn't have insurance.

Of course, simple comparisons never tell the whole story. In 1934, antibiotics were still more than a decade away. Many more sophisticated and expensive life-saving machines, medicines and procedures we take for granted today were not available. While I don't know the extent of my wife's grandmother's complications, it's doubtful they would require so long a hospital stay now.

But do hospital visits have to cost as much as they do today? If not, what can be done about it? These ought to be the questions driving the debate in Washington, not questions about how to extend insurance coverage to everyone. Focus mainly on costs and the coverage problem begins to take care of itself.

Any red-blooded capitalist can tell you that costs come down as more and more people compete to provide the same service.

The minute you decide to go down this road, however, you get arguments from some that health care is not a commodity and that it won't respond to competitive pressures. If you're suffering a heart attack or bleeding in the street after an accident, you won't take bids from competing hospitals.

But then, if your car breaks down on some lonesome highway, you likely can't choose your mechanic, either. That doesn't mean consumers don't benefit from competition among auto-repair businesses. The overwhelming majority of us interact with the health-care system in ways that do respond to competition and transparency.

Last week the Senate Finance Committee approved a version of health reform that contains a framework for what Washington has in mind. Among other things, it would tax expensive insurance policies to help people who can't afford coverage. It would force insurers to follow tougher specifications and to cover more people.

It would, in other words, do things likely to keep consumers far removed from the actual costs of what they are receiving, while driving up premiums.

A few years after my father-in-law's mother was released from the hospital, health care began to evolve in this country. During World War II, the Roosevelt administration prohibited companies from raising wages, so companies began to compete for workers by offering health benefits. Then Washington voted to exempt employer contributions to insurance from taxes. Before we knew it, being insured became synonymous with being employed.

That, as it turned out, was not the best path. And while we can't return to 1934 (nor should we), we ought to find ways to at least make health-care costs and insurance coverage competitive.

Jay Evensen is editor of the Deseret News edito?rial page. E-mail: [email protected]. Visit his blog at