I was very surprised that President George Bush brushed over the health care crisis in his State of the Union address earlier this week. "Crisis" is not an exaggeration. Nearly one-quarter of Americans walk around in a precarious state absent health care insurance, yet this country expends nearly 15% of its gross domestic product (GDP) on health care. That figure is almost double the percentage of GDP expended by other industrialized nations.

Burdened down by rising costs, American businesses are finding it increasingly difficult to compete in a global economy.

Mind you, I was not anticipating any creative solutions to the health care
crisis to come out of the State of the Union address. The Bush administration's recent rhetoric focuses on consumer-driven reforms.

Translation: the weight of higher health care costs will be shifted to individual Americans. It is an alarming trend.

At the moment, the majority of Americans receive health insurance through their employer, and we are paying considerably more today to maintain those policies than we did even two years ago. American companies are not simply turning mean; truth is, most companies cannot keep pace with the runaway costs of health insurance and stay competitive. Companies are passing along a portion of those rising costs to their employees.

So, instead of doing the hard work of addressing the corporate graft that pushes health care costs upward, the Bush administration plans to put the squeeze on the average American worker to make choices about how much health care his or her family "really" needs. In this new paradigm, risk for illness or injury is not distributed across the board; rather, each individual must assume that risk for oneself. Pay as you go; if you need health care, that's your problem.

What do I mean by "corporate graft that push health care costs upward?" A personal story will help me make the point. Last year I was flying back to San Francisco from a East Coast event. I pulled out my Apple Powerbook - you know, the silver one with the apple illuminated that you often see in movie ad placements - and started typing away. After a few minutes, the woman in the adjoining seat interrupted my train of thought: "Excuse me, but do you like that computer?" I gushed a bit - I do love my Mac. I guess I convinced her, because she concluded, "Well, good, I am going to get my client to buy me one of those."

Well, that piqued my curiosity; after all, what kind of "client" buys high-priced computers for a consultant? So I politely asked her what line of business she is in. "I'm a surgeon," she replied. "Hmm," I paused then said, "so your hospital will buy you a laptop?"

"Oh no, not my hospital," she said with a laugh, "the medical device company that I use will do that without blinking." She went on to describe how she and her daughter (sitting in front of us) were on a junket to San Francisco, all paid for by her medical device company. Once assured of my interest, she carried on to tell me about the fabulous all-expenses trip to the Caribbean she took over the summer under the guise of training and education of company products.

My airplane encounter came to mind this past week when my eyes ran across a feature story on the front page of The New York Times business section: "Whistle-Blower Suit Says Device Maker Generously Rewards Doctors." The suit, accuses Medtronic, one of the country's largest medical device makers, with $10 billion in sales, of giving surgeons "excessive remuneration...and bribes in other forms for purchasing goods and medical devices." Because the devices that Medtronics - and believe me, they are not the only guilty party in the medical device field - sells are so expensive, providing perks to the doctors is a relatively cheap cost of sales.

Please do not assume that all medical doctors are on the gravy train. I know a gaggle of doctors who are committed to delivering the best care possible for their patients. However, I did uncover in my latest book, Saving the Corporate Soul, that graft in the Medicaid system and unscrupulous business arrangements between pharmaceutical companies and physicians is rampant. For example, some physicians, in exchange for money, allow pharmaceutical sales reps into their examining rooms to meet with patients, review medical charts and even recommend which medicines to prescribe. In a somewhat recent survey of doctors in the state of Maryland 37 percent of physicians admit that they accept some kind of compensation from pharmaceutical companies.

Addressing the graft in the system takes political courage from our elected officials. Unfortunately, such fortitude is lacking in the Beltway. They, too, are probably getting perks for their considered interest. How much easier is it to ask individual Americans to tighten their belts, and take responsibility for runaway health care costs?

The immorality of the system makes me sick.