Today, I come back to the tragedy of medical economics in this country. And I would apply that word “tragedy” in at least two ways.

The first tragedy is that we are headed for fiscal disaster in this country because of healthcare costs.

We now spend twice as much per person on healthcare as the average per person cost of all developed countries. During the past several decades, the inflation rate for healthcare costs has usually been two to three times the general inflation rate.

Obviously, this level of healthcare cost increase cannot continue. It is, to use the favorite word of the day, “unsustainable.”

But lost in this economic tragedy is the even more important human tragedy.

Because healthcare costs are soaring (I believe last year’s somewhat lower costs were primarily due to the recession) 40 to 50 million Americans have no health insurance largely because they or their employer can’t afford it. Even though we are the richest country in the world, we are the only developed country in the world that does not have universal health insurance. Unbelievable but true!

And given the power of the medical-industrial complex to produce and politically protect (with a huge lobbying arm) high cost tests and treatments, there appears to be little hope of stemming the tide of rising costs.

Which is why I predict that the healthcare cost crisis will drive us to a real fiscal cliff within 10 years at which point I would guess the desperate politicians would hold an emergency meeting in Washington (much like the banking crisis) and probably decide to expand Medicare to cover everyone simply to get the “supply line” of cost in one place in a frantic attempt to get control of it.

The only hope of avoiding this scenario is the “medical home” concept I had described. That’s because the only hope of avoiding unnecessary healthcare costs – before it is too late – is a primary care “system” where trust abounds and “patients” become “partners” in a decision-making process that allows rational decisions to be made about healthcare – rather than the emotional decisions too often made today out of fear and/or greed.

For the “medical home” concept to truly work we will also need to remove the “fee for service” incentive that basically says “the more you do, the more you make.” And we need to develop comparative data – and make it readily available – that tells us what works and what does not, in other words what is “cost effective.”

With payments based on “outcomes” and “results” and information available to guide decisions toward “outcomes” and “results” I think we could have a fighting chance to stem the tsunami of healthcare costs before it is too late.

So I personally will be evaluating any and all proposals about healthcare reform on the basis of how well they promote this kind of primary care. I have come to believe it is our only hope in stemming cost and – more important – providing care that is more helpful than harmful.

Timothy Johnson trained as an emergency room physician but switched careers in 1984 when he joined ABC News as its first full time Medical Editor. Although he retired from that role in 2010, he continues as Senior Medical Contributor.  He blogs at Timothy Johnson, MD: On Health.