“The rising costs of health care and health insurance pose a serious threat to the future fiscal condition of the United States. Under current policies, CBO projects that federal spending on Medicare and Medicaid will increase from about 4 percent of gross domestic product (GDP) in 2009 to nearly 6 percent in 2019 and 12 percent by 2050. Most of that increase will result from growth in per capita costs rather from the aging of the population.”

Unless the government is profiting from Medicare, it appears that there really is an increase in health care costs above and beyond the insurance companies’ profits. Moreover, private, for-profit insurance companies actually make up a minor component of health care spending.

According to the data from the Alliance for Advancing Non-Profit Health Care, 48 percent of Americans with private health insurance are actually covered by nonprofit plans (like Blue Cross and Blue Shield plans), based on health plans with an enrollment of at least 100,000 members.

Let’s do the math to see the effect of the public option: A recent analysis by economists at the Agency for Healthcare Research and Quality found that the public sector accounted for more than half (56 percent) of all health spending within the civilian non-institutionalized population.

Forty-eight percent of the rest are covered by not-for-profit insurance plans. Therefore, we are about to control American health care cost growth by reducing the profits of the 25 percent of spending in the private, for-profit insurance sector.

Fortune magazine reports that sector’s profits are 3 percent. If we cut their profits in half, we will save 25 percent (private, for-profit share of insurance spending) of 1.5 percent (half of private insurance profits); that saves $10.8 billion a year (equal to 0.4 percent of U.S. health care spending).

That leaves more than $70 billion to $100 billion a year to be funded through increased taxes or cuts in health care spending if we accept the CBO’s latest assessment of the cost of the Baucus bill. And that will still leave 7 percent of the U.S. population without health insurance. That amounts to about 20 million people.

Medicare really defines health care in the United States. Private insurance companies pay hospitals and physicians pretty much in the manner that Medicare pays them. Because Medicare and its cousin, Medicaid, are far and away the largest insurance companies in the U.S., they really are to “blame” if there is a problem with American health care costs.

Next time you get to participate in a town hall meeting with your congressman, try to get an answer to how he or she plans to control health care costs given the arithmetic of how it all is paid for now.

Please try to find out how the “public option,” saving $10 billion each year, is going to solve our health care system’s 40 percent excess cost compared with the supposed highly desired health care system of Canada. That 40 percent is equal to $1.08 trillion. It just does not add up.

So why the public option? It cannot really cut into the cost of health care, certainly not the rising cost of Medicare. There is only one reason, and that is ideology and political philosophy — not “keeping the insurance companies honest.”

What we really need is an honest discussion from our political representatives of how we will control health care costs. We probably will not like what we hear, but at least it might be the truth.

Dr. Stanley Goldfarb is associate dean of clinical education at the University of Pennsylvania School of Medicine and a nephrologist. This article is reprinted from The Weekly Standard.