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IT'S LIKELY you have noticed there's an election about to happen. Whichever candidate gets in is going to have to deal with a broken and very expensive health care system and a huge deficit. Not a good combo. They will be trying to make a silk purse out of a sow's ear.

This prompts me to give them my take on how to reduce costs.

There's a lot of noise about malpractice insurance, inefficient insurance companies, cost of drugs, poor communication systems.

But the effect these have on the cost of care is chicken feed compared with the money that doctors have control over, especially with hospitalized patients, in an environment where there is no incentive to save costs.

SOARING COSTS

Let me present you a few depressing statistics. Health care costs have skyrocketed--the U.S. spends twice as much per head as France, for example, and this has doubled between 1970 and 2006 (from 7 percent to 15.6 percent of GDP). It is projected to double again in the next 10 years.

We spent $2.3 trillion in 2007--making the bailout look paltry by comparison. But the U.S. health care system is ranked 37th by the World Health Organization--France being No. 1. And there are those oh-so-troublesome 47 million uninsured still, all in the wealthiest country on the planet.

Of all these big bucks, 80 percent are spent on 20 percent of recipients--the sicker, usually hospitalized patients. And who mainly controls the purse strings here? Doctors. Doctors receive or control an estimated 87 percent of health care spending, according to a report by Alan Sager and Deborah Socolar of the Boston University School of Public Health.

We doctors are a capricious lot, or so it would appear from the likes of journalist Shannon Brownlee, whose book "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer" seems to jibe with my own observations.

We do what we do in large part due to attitude and tradition, she claims. She cites a study by Dr. John E. Weinnberg of the Dartmouth Institute for Health Policy and Clinical Practice. In the study, two towns, with no significant difference in health profile, showed 10 percent of children in one town had had tonsillectomies, versus 70 percent of children in the other--just because that was the culture in the second town.