Among serious policy experts and political operatives, when either Democrats or Republicans talk about reforming health care, providing for the uninsured and lower costs, their honest reaction is rolling of their eyes or snickering or a sad shaking of their head.

The reason that reforming health care in any meaningful way has failed — with the exception of what the Republican controlled Congress accomplished — HIPAA, the Medicare Prescription Drug Plan and Health Savings Accounts — is that of all types of political action, reforming health care has the highest degree of difficulty.

There are a number of reasons for this:

i) Massively funded vested interests, who feed off Medicare, Medicaid and SCHIP;

ii) An easily manipulated senior population who elected politicians are loath to cross;

iii) General policy confusion as to the real cost drivers of health care (hospital prices — often mislabeled as technology prices);

iv) The complicity with which insurers accept higher prices in order to drive their premium prices higher, and, therefore revenue and profits higher;

v) The hard-core wing of the liberal Democrats who want a single payer system which will not occur anytime soon, but divide the Democrats and whom are easily provoked into marginalizing themselves in public opinion; and,

vi) The fact that the single payer system most well known to Americans — the Canadian system — is in the process of adding a large private sector component to its government run health care because it is running out of money and cannot serve Canadians at the level it should, which caused the Canadian Supreme Court to recognize this fact and allow the private sector to fill in the gaps. (In Canada, this is the equivalent of standing up and screaming the King has no clothes.)

But the biggest road block to serious health care reform in the United States is the one written about in today’s New York Times by Robert Pear: how, exactly, can health care reform succeed in the United States, when Medicare and Medicaid are taking such a massive chunk of the federal budget?

Pear writes: “the two programs, for older Americans [Medicare] and low-income people [Medicaid], [1] cost $627 billion last year and accounted for 23 percent of all federal spending. With no change in existing law, the [2] Congressional Budget Office says, that cost will double in 10 years and the programs will account for more than 30 percent of the budget.”

Further, the baby boomers have not even begun to hit the Medicare population, and use its services. Boomers will grow the Medicare population from the 44 million now, to 55 million by 2017.

But adding 25% more seniors to the Medicare population in the next nine years, is not the biggest cost driver. Let me repeat, adding 25% more seniors to the Medicare population in the next nine years is not the biggest cost driver.

As Pear reports, “Peter R. Orszag, director of the Congressional Budget Office, said, ‘The bulk of the projected increase in spending on Medicare and Medicaid is due not to demographic changes, such as increases in the number of beneficiaries, but to increases in costs per beneficiary.’”

Readers may remember the $600 toilet seat the Pentagon was beat over the head with for years — well, the equivalent of that is the high rates hospitals are charging. But since the public at large has no relative way to know what a reasonable price of a hospital service should be — there is no outrage. (Maybe a hospital toilet seat is supposed to cost $600.)

For those who do not believe that $627 billion a year will not draw waste, fraud and abuse on the scale of what happened during the Reagan military build-up, I hope you have a pleasant experience when you leave your tooth under your pillow for the tooth fairy.

Even the Democrats acknowledge there is waste. As Pear reports today, “research ’suggests that about 20 percent of Medicare spending could be eliminated with no adverse effects on health,’ said Prof. David M. Cutler of Harvard, an adviser to the Obama campaign.”

As for Hillary Clinton, Pear writes: “Mrs. Clinton says her plan will save more than $50 billion a year with ‘efficiency reforms.’”

The sign that no one can tame the great demand for health care services per senior and the dollars going to them is that the per beneficiary cost is the biggest cost driver.

Obama’s Harvard advisor, Cutler, says that finding the 20% of Medicare spending to cut would be “very difficult,” Pear reports.

The fact is, no one government entity, bureaucrat or system can make the decisions about which 20% to cut, and expect any rational outcome.

There is one way to have the best decisions made the most often, and that is to have the individual senior decide how to spend their Medicare dollars in the fashion best for them.

Senator Inhofe (R-OK) and Senator DeMint (R-SC) have a proposal (S. 173) to fund a Medicare Savings Account at 90% of the Medicare rate per senior, which allows the senior to decide, below their 100% coverage deductible how to spend their money. This proposal would save 10% per senior right off the bat.

Another money saving proposal would be to eliminate the Medigap zero deductible, and if it became $500 dollars, would save at least $750 per senior, according to one expert.

When you look at the big picture, the Democrats have a whole lot to lose in the next Congress. If their reforms for health care become unpopular, or they over reach or they impose government controls, the American public will reject them. And each day, their financial maneuvering room becomes less and less as the twin government run health care programs consume more and more resources at an unsustainable level.

Interestingly, here is how Robert Pear ends his article, fittingly, if you can read between the lines:

“Senator [3] John McCain of Arizona, the presumptive Republican nominee, describes Medicare as a ‘fiscal train wreck.’ He voted against adding a prescription drug benefit to Medicare in 2003 because, he said, it added huge costs to a program going broke.

“Mr. McCain says he, too, wants to cover more people. But he has not explicitly embraced the goal of universal coverage, saying he worries more about costs.

“Public opinion polls show broad support for federal action to cover the uninsured. But [4] Robert D. Reischauer, a health policy expert and president of the Urban Institute, said, ‘It will be difficult for Senator Clinton and Senator Obama to retain popular support for their plans once the details are specified.’”