I was recently asked to speak to a gathering of hospital-sponsored health plans and providers of health care services about our health care system, and trends I see developing which threaten it. I’d planned to talk about how the Patient Protection and Affordable Care Act (ACA or Obamacare) only targets one-third of the health care system – that being payers (insurance), while mostly ignoring the other two-thirds: providers and patients. Call it a scapegoat, or something else, but of the three players in health care, insurance is the villain. It’s easy, then, to say that what’s wrong with health care is what’s wrong with insurance, and vice versa. As such, fixing health care then becomes fixing health insurance. Rather than assign blame to all three – providers, patients, and payers – it’s politically expedient to point a finger solely at the least popular of the three: the payer. And so, health care reform became health insurance reform; but as I’ve said many times before, insurance isn’t health care – it’s a way to pay for health care. This idea that insurance is to blame for the overall cost of health care, that it can strong-arm providers into taking whatever they want to pay, and thus, the rising cost of insurance is based solely on greed and not at all on the actual cost of the care, is a lie. There is another attitude that it’s easier for insurance to raise premiums than push back on the cost of care, because pushing back on providers is tough, and – for the insured – not having insurance means certain death (and thus they will pay any premium). This holds a little more water; however, it wrongfully assumes that without insurance there is no health care. Yet, the truth is that health care would exist with or without insurance; we’d just need to find a different way to pay for it. People “need” insurance – not for its own sake – but to pay for health care, because health care itself is too expensive.