Hospital bills are impossible to understand.

Health care is complex and sophisticated, utilizes cutting-edge technology and offers hope of cures from many of the common illnesses that lead to suffering and death. As an industry, it remains highly profitable. According to federal actuaries at the Centers for Medicare and Medicaid Services, $2.6 trillion is spent on health care annually. More than half of that is paid to hospitals and physician/medical clinic services.

In 1961, as he was about to leave the presidency, Dwight D. Eisenhower warned of the dangers of a military-industrial complex that, driven by profit, could lead to serious dangers to the American way of life. Today we are just as threatened by the medical-industrial complex, which wields enormous sway over policy and the care delivered to the nation. Policy decisions are influenced significantly by the lobbying clout of all stakeholders whose concerns are determined by their own vested interests and bottom lines.

Despite the costs, the health of individual Americans varies widely. Major predictors of health are the wealth of the individual, whether he has insurance, access to health care and level of education. If you are poor in America, less educated, live in rural areas and lack insurance, you are likely to be overweight, have life-threatening illnesses, receive inadequate care and die at a younger age.

Unlike his options in other areas of the economy, the individual consumer will never be able to take advantage of a competitive marketplace to save money and drive down costs. This task can only be accomplished by the federal government and insurance companies that, because of their economic clout, can negotiate the best possible deal from providers of health care. The most influential payer is Medicare. Patients over the age of 65 and covered by Medicare pay the least; commercial insurance clients come next, and the uninsured pay the most.

A recent investigative report in Time magazine by Stephen Brill described "Why Medical Bills Are Killing Us." He tells the story of a man recently diagnosed with lymphoma. As a small businessman, all he could afford was insurance that paid a maximum of $2,000 daily for a hospital stay. MD Anderson Cancer Center, the hospital of his choice, refused to accept his insurance and required several upfront payments that totaled more than $80,000 (including $7,500 just to get the doctor to see him). He was required to pay $1.50 for one pill of a generic version of Tylenol and was charged $283 for a chest X-ray, for which Medicare pays $20.

And the cost of his treatment was $15,000 for one dose of the medication Rituxan, which cost the hospital less than $3,000.

MD Anderson has vigorously pursued this family, and as a result, they have lost everything.

Brill states, "We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more each year on artificial hips and knees than Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25 percent to 75 percent more for this equipment than it would cost at Walmart."

Hospitals point out that health care is complex and payment systems reflect the need to make up for losses that occur because of charity care and low payments by Medicare. But if you have an income and inadequate insurance, you are doomed.

Brill maintains that every element of our health care system inflates costs. Physicians are blamed for unnecessary and unduly expensive care; diagnostic and pharmaceutical companies gouge Americans because of powerful regulation of costs globally. As a nation, we spend more on health care than the next 10 biggest countries' health care costs combined.

And costs vary substantially from health care system to health care system. Some have financial aid for those who are unable to pay; others do not. Small and rural hospitals struggle to make ends meet and are being squeezed out by larger systems with substantial economic clout.

The bottom line: Our health care system is seriously flawed. Everyone I know celebrates turning 65 enthusiastically because at long last they have their Medicare card. I hope that future reform will focus on making health care more accessible, affordable and rational. Care must be based on proven evidence of benefit, and billing must be as realistic and as transparent as possible.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at:

www.drdavidhealth.com