With every passing month in America's "jobless recovery," more jobs are lost. Lost jobs in the U.S. quickly morph into uninsured lives. In April 2008, the Kaiser Family Foundation calculated a metric that showed a 1 percent increase in the unemployment rate leads to a 1.1 million person increase in the uninsured and a 1 million person increase in Medicaid enrollment.

That was April 2008 -- this is November 2009. State governors, who fund one-half of Medicaid, are hard-pressed to absorb these hundreds of thousands of lives. Then what? The number of the uninsured increases.

"I'm insured, so should I care?" ask Harry and Louise. Based on recent surveys on American attitudes about the health-care safety net for people 'other than me,' it appears the European model of social insurance is seen by many American health citizens, still, as socialism, not insurance.

The sooner we get uninsured people covered -- while rewarding quality care, not paying for poor outcomes, moving our paper-based system to digital platforms and better managing the allocation of scarce health resources -- the better. Yes, it's complicated. But with each passing month in the jobless recovery, more people will move into the uninsured pool of Americans. Watch for emergency room waits and hospital/provider bad debt to grow.

Of all the major flaws in our health care system, high cost is the most destructive. One out of every six dollars is currently spent on health care. By 2018 that figure will rise to one in every five dollars. And in the recent time of significant economic expansion the annual inflation in health care costs outstripped the growth of our gross domestic product by more than double. This trend is neither desirable nor sustainable.

Why is that? In our country the vast majority of care is provided by uncoordinated, independent providers operating in an financial environment that rewards more care. Not better care. Not coordinated care. Not care based on the best available evidence. Health care financing in the United States is simply not set up to provide coordination for physicians, hospitals and patients in determining the right care, in the right place and at the right time.

How and where health care is delivered should be a major component of any reform agenda aimed at both reducing cost and improving the quality of care. In other words we need to create a health care system. A few entities have done this by both aligning and coordinating the delivery and financing of care. Kaiser Permanente, Group Health Cooperative and Intermountain Healthcare are a few examples of organizations that bring physicians, hospitals and financing together to meet the needs of patients. Currently these care settings are not available to all Americans, a result of a financing system that rewards uncoordinated care. So while a model exists for how it can happen in this country, most physicians and health care practitioners do not practice in these environments. We have to ask ourselves -- why is this true? Why do the majority of physicians choose to practice in a non-integrated environment?

The unrelenting rise in health care costs is a burden to individual patients, employers, governments and our nation's ability to compete globally. Is it possible to rein in the cost of health care? Yes, but minor changes to the current manner in which we pay for care only perpetuates more of the same - more uncoordinated care at a higher cost. We need change that rewards coordinated care aimed at bringing physicians and hospitals together in the best interest of the patient.