There was a day when a trip to the doctor for a routine condition could be paid out of pocket without sending a family into bankruptcy.

But today, a family without insurance can hardly afford to spring for treatment of even the most routine physical ailments. And even with insurance, co-pays and deductibles can eat away at their savings.

That's why health care costs have been a key topic in election campaigns for years and remain a key issue in this fall's presidential race. But a solution has been impossible to come by, largely because of the major difference between the two political parties into how great a role government should play in our medical care.

Democrats favor a more active role, ranging from a government safety net of insurance for those who need it all the way to a federal takeover of health insurance. Republicans prefer a market-based approach and more options to help people acquire insurance and save for out-of-pocket expenses.

That's roughly where we are in this year's presidential race as well between Democrat Barack Obama and Republican John McCain.

Whatever one's views on government's role, there is agreement that changes are needed. As costs continue to rise, too many Americans are having to forego necessary health care needs, often bypassing doctor visits when the money isn't there.

Uninsured patients account for some $86 billion in U.S. spending this year, according to the Kaiser Family Foundation. That organization also estimates that insuring those who lack it will cost even more, some $123 billion a year.

Some 47 million Americans still don't have insurance provided by an employer or other source, leaving them vulnerable to a catastrophic illness. As a result, many seek care in hospital emergency rooms, which are obligated by law to treat all patients. Yet the cost of ER care is prohibitive compared to private practice physicians, driving up the price of health care for everyone.

Health care costs now account for $1 of every $6 spend in the U.S. economy, according to the Congressional Budget Office, compared to $1 out of $10 in 1960. The CBO estimates that will reach $1 for every $4 spent by 2025, one-quarter of our spending incomes. Such a drain takes away from money that could be spent on other individual and societal needs.

Businesses foot the bill for a huge share of their workers' health insurance needs, taking away from their ability to invest in growth and provide greater salaries and benefits. With the economy slumping, companies are squeezed at both ends, trying to maintain their employees' expensive coverage even as their own bottom lines suffer. It's a tough balancing act, one that has led many businesses to cut back on coverage, or worse, cut back on the number of workers they can afford.

Thus, health care is not just a quality-of-life issue, but also an economic one. As long as the American people and their employers have to burn so much of their income on health needs, turning around our slumping economy is made more difficult.

There are numerous causes for skyrocketing health costs. Indigent care is a major factor, along with malpractice lawsuits that have driven up the cost of insuring doctors. The risk of lawsuits also leads many physicians to err on the side of extreme caution when treating patients by ordering expensive tests that may not be needed, driving up costs even more.

The first step toward getting a handle on runaway costs will be finding a more cost-effective way to treat indigent patients that provides the level of care they need. Many communities are doing this through free or low-cost health clinics to stave off serious conditions early before more costly treatment is needed.

Last week, Gainesville opened a new wellness clinic for city employees to treat routine illnesses, exams and prescriptions. Good News Clinics is another local option for those who lack insurance or the ability to pay doctors' fees. Government can encourage these community-based solutions by offering incentives and startup money to expand and maintain such clinics for everyone.

Government also can assist small businesses who have a hard time affording insurance for their employees. Group rates are preferable to individual policies, and the more workers that employees can get onto insurance rolls, the better. Tax breaks for businesses that make this effort are an easy fix that both parties agree on.

Another idea both candidates agree on is that health insurance should be portable, allowing workers to maintain coverage when they change jobs. The gaps and waiting periods during such transition can be costly and devastating when an illness hits.

The federal government also can fully fund state-run programs such as Medicaid and SCHIP for poor children. Millions of Americans benefit from these plans, but many states, including Georgia, have trouble maintaining the quality of care and accessibility these plans offer. Keeping sick kids out of classrooms where they can infect others is a shared goal.

Most agree as well that insurance companies need to be more lenient in covering those with pre-existing conditions. When an insurer drops someone from a policy because of their high risk, we all pick up the tab.

Lowering costs across the board should make it more viable for providers to maintain coverage for everyone.
And we can all do our part as well by maintaining healthy lifestyles and managing our family health care expenses wisely. It's not government's place to tell us how to live, but when we run off to the doctor for mild conditions, we jack up the cost of care for everyone.

The idea of creating a federally-managed health plan that covers everyone is a tough sell in our current political climate, and may not guarantee that costs or services would improve. That's why both candidates prefer to chip away at the problem with smaller steps designed to bring costs in line while providing more coverage to more Americans in a market-based approach.

That appears to be a wise starting point for fixing the problem, one that will require some compromise and cooperation from our leaders but is well within their ability to do so.