Let me explain.

Take the case of the providers and facilities for example. Professional services and inpatient hospital stays account for over 60 percent of health care claim expense. For us to recognize meaningful cost reduction, doctors and hospitals are just going to have to get by with less. This means less money in terms of salary, fee schedule reimbursements, tax subsidies and exotic trips paid for by Big Pharma under the guise of continuing education.

To lower cost, we can also look to criminals. These are the cheats, the fraudsters within the system who cost the system billions annually in the Medicare system alone. In some cases these, too, are physicians fraudulently billing for hundreds of services per day. In other cases we see chiropractors and patients working in tandem, staging an injury to defraud the system. To lower the total health care bill, criminals like these will simply have to get by with less; less in terms of our dollars and their freedom.

The same is true of lawyers. Frivolous claims of malpractice in pursuit of quick settlements or large punitive awards are an added drag on cost. The added health care expense associated with this source is twofold: direct and indirect. The direct cost comes from settlements and judgments against insurance carriers, doctors, and hospitals. Indirectly, the stakes are much greater. To defend against the possibility of a threatening lawsuit, these same carriers, doctors and hospitals are forced to perform and pay for services and tests that otherwise would not happen. For the system to recognize lower cost, meaningful tort reform must be enacted. Said another way, lawyers will simply have to do with less.

In the case of the insurance carriers, they will simply have to cut overhead expense. There are multiple options for this, but the idea is simple enough. Advertise less, pay brokers less, reduce customer service staff, sell the corporate jets and the like. Perhaps insurance executives will have to take less in the form of compensation. Maybe stock holders will need to accept less in the form of dividends. Bottom line – if we want to lower insurance cost, the insurance company will, at least in part, have to do with less.

But, really, these items don't add up to much when the savings is spread over 300 million people. Yes, there are mountains of cash in all of these areas. But stop and think. When we squeeze the insurance company, who is merely a middle man, look at where they will save the money – lower commissions to brokers (ugh!), fewer staff, reduced advertising budgets. Telling the insurance company to do with less is really telling them to fire additional low-level staff, pinch the sales staff compensation (brokers) and put some graphic artists on the street. How much real money is there in overhead expense to cut?

The dirty secret is that savings – meaningful savings – has to come from patients making do with less. PriceWaterhouseCoopers – AHIP 2008 study of health care cost found that, on average, 87 percent of health care expense is the claims themselves. Only 13 percent is paid, on average, as overhead and administration. To hear the pundits talk, you'd think we could insure the uninsured, improve access for all, remove pre-existing condition limitations, and xpand coverage to the underinsured by reducing administrative expense and eliminating fraud.

But these items are nearly all cost increases! How do we pay for all of this without "…adding a dime to the budget deficit"?

The answer is simple – patients will have to make due with less. Less services, less doctors, fewer beds in hospitals, fewer MRI machines, longer waits, fewer drugs … less period. Less services when you are aged; no knee replacements when your net contribution to society is deemed less than the cost of the operation. Fewer drugs when you get sick. Just plain less of what we are used to now. These types of imposed reductions are better known as rationing.

If you doubt me, look at H.R. 3200. What do you think the committees, boards, and commissions all provided therein are for? Reduction in services (necessary or otherwise) rendered to patients is the only way to attack 87 percent of the health care bill. It is the fastest way to reducing health care cost. But it is also the most politically explosive – remember "death panels"?

But rationing is not the only way for patients to do with less. While rationing is the imposed form of cost reduction, improved health status is its much lovelier, non-imposed twin. Indeed, consumers could do with less soda, chips, and ice cream. We could do with less weight and more exercise, less tobacco and more salad. More PE and less TV. In many ways, the excess cost in our system is self-imposed. Better health status equals lower health care cost. This much is intuitive. The cost savings equation is not a one-way street right out of the wallets of others; we individually all bear some of this burden.

"We the people" will have to make do with less voluntarily or involuntarily if we are to lower our health care cost permanently.

I am not a pessimist. I'd prefer to see us voluntarily improve our overall health status. The formula is simple. Someone has to do with less in order for health care costs to come down. And everyone can contribute in some way.