To understand how hard it is going to be to control health care costs, one merely has to consider the outrage surrounding TSA’s recent roll-out of “enhanced security” measures – measures which include ‘enhanced pat downs’ and full body scans.

Videos of boys getting patted down personified the problem. But the upset and outrage and anger visible today will be nothing if another airplane gets blown out of the sky; then we’ll see – and hear – about the gross negligence that allowed the terrorists access to a plane full of people.

We want to have our cake, eat it too, and not get fat.

Folks, we need to get the deficit under control. We can’t afford the future bills for health care entitlements. Yet many of the same deficit hawks outraged by government spending are also the loudest voices protesting cuts to Medicare and angry about reducing physician reimbursement.

This is going to hurt everyone – you, me, my ninety-year old mom, doctors, the poor, the wealthy, hospitals, supply companies, pharma – you name it. We can either whine about how unfair and awful this is, or get serious.

A good place to start is the President’s deficit commission’s approach.

Here are a few things to consider

– Speed up cuts to Medicare Advantage and charity care payments to hospitals, both provisions in the ACA.

– Beef up and empower the Independent Payment Advisory Board, the newly created commission charged with slowing the growth in Medicare spending.

– Means-test seniors’ contributions towards their health care.

– Quickly implement a strict cap on the amount of employer-provided health insurance expenses that are tax deductible – a much lower cap than called for under the ACA (that kick in until 2018).

And here are a few ideas from your author:

– Raise Medicare-specific taxes. Much as I dislike paying taxes, I dislike dumping the costs on my – and your – kids even more.

– Allow the federal government to negotiate prices with pharma for Part D; either that or cancel the program altogether. That’s $15 trillion right there.

– Require Medicare to alter payment based on the effectiveness and efficacy of various treatments – a rather obvious step that – believe it or not – is illegal today.

– Require individuals with modifiable risk factors to pay more – or get less – if they refuse to work to get healthier.

What does this mean for you?

This is about shared sacrifice. While the ‘enemy’ isn’t as easily personified as a terrorist or nuclear power, it is every bit as dangerous and threatening. Real, verifiable, tough steps are necessary. We’ve handled this before, and we can do so again, but only if we get serious.

Alas, the cynic in me doesn’t think we will get serious. The deficit crisis isn’t going to manifest itself in a highly-visible televised explosion or plane falling out of the sky; no pictures of bloody victims staggering away from a dust-filled street, no shattered buildings with blown-out windows and screaming sirens.

Just a deeper and deeper hole sinkhole that will slowly – but surely – swallow our future.

Joseph Paduda is the principal of Health Strategy Associates, and blogs at Managed Care Matters.

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