The worsening national health care crisis has mostly slipped from the headlines lately in the rush to pass a federal stimulus package. Congress is talking about expanding children's health care and there has been some discussion of the Medicaid funding for the states in the stimulus plan, but that's about it.

The stimulus package does include important health care provisions, investments in health information technology and evidence-based prevention, but the big debate about health care has yet to begin. Let's hope it happens soon for the sake of the 40 million people that don't have health insurance, 1.4 million of them in North Carolina.

And the numbers are growing everyday as layoffs and home foreclosures continue. The price of waiting is going up too, even for people who currently have coverage.

 A new national report finds that the premiums for employer-based health care will almost double by 2016 unless federal policymakers do something about it.

The study by U.S. PIRG  finds that the yearly cost of the average employer-paid family health policy in America will increase from $11,381 in 2006 to $24,291 by 2016.

Most of the increase comes from unnecessary care, high administrative costs, and expensive marketing campaigns. The report points out that insurance companies pay doctors based on the number of tests and procedures they perform, not the overall quality of care.

Administrative and marketing costs are skyrocketing. Pharmaceutical companies have increased spending by 250 percent in the last ten years and spent $11.5 billion in 2005 promoting their most expensive drugs.  That leads to the overuse of new, heavily advertised, and more costly drugs that may not work as well as older medications.

The report reinforces the need for a sensible, universal health care plan at the federal level, but there are plenty of things North Carolina lawmakers can do this year and plenty of questions they need to ask.

Adam Searing with the Health Access Coalition has some places to start to save money and improve care, including the creation of a model preferred drug list, expansion of the successful community care program, and investment in a collaborative health research institute. 

Here are a few more. The expected $300 million dollar shortfall in the state health plan ought to prompt lawmakers to take a look at the administration of the plan by Blue Cross and Blue Shield. Family members of state employees are increasingly opting not to pay the almost $500 monthly premium for family coverage in the state plan and are instead buying private policies with guess who, Blue Cross.  Younger and healthier state employees would be silly not to at least consider separate policies for their spouse and children.

That means the state health plan pool shrinks and gets older and more expensive to cover, driving the cost of the plan up further. Legislators in both parties are now discussing the possibility of considering the state health plan enrollees and individual Blue Cross policyholders as one large pool to reduce the average cost.

Lawmakers ought to resist the apparent temptation to cut funding for HIV/AIDS medication and prevention, community health programs, maternity clinics and other public health services that save the state money and help people who need care.

And they ought to follow House Majority Leader Hugh Holliman's advice and ban smoking in bars, restaurants, and worksites to protect workers and the public from the deadly effects of secondhand smoke.

The health care crisis hasn't gone away in North Carolina. People who couldn't afford to see a doctor or pay a $500 monthly premium last year still can't afford to.  And every day more people are facing that reality for the first time.

The General Assembly needs to face it too, budget crisis or not.