Before state legislators consider the hundreds of health-care related bills in front of them this session, I hope they consider a health care bill that I have in front of me. Their bills are proposed health care laws, mine is a million-dollar hospital bill. Their bills are for the health care of millions, while mine is for the care of just one patient, injured when he was thrown out of his crashing car because he was not wearing a seat belt. Their bills are written in legalese; mine is written in blood, pain, misery, and lost opportunity. It’s a million-dollar bill for the freedom to go unbelted.

Despite the differences, their bills and mine have everything to do with each other. This year the Maine Legislature has before it bills to allow someone to be ticketed for driving without a seat belt (so-called primary enforcement of mandatory seat belts), and to ban the use of hand-held cell phones while driving. While these are bills designed to save lives, they are also litmus tests of this question – do our elected leaders have the legislative gonads to do what it takes to rein in health care costs? Do they have what it takes to stare down health insurance companies, doctors, hospitals, employers, lawyers and all of us, as we appropriately stand up for our self-interest but in doing so sometimes stand in the way of putting the brakes on health care spending?

While these two bills are Maine’s, other states have their own litmus test bills. Connecticut and New York, for example, both have primary enforcement seat belt bills and ban hand-held cell phone use while driving but are considering bills to reduce health care related infections. California and more than 20 other states are considering bills to reduce the number of residents without health insurance.

Each of those bills asks legislators if they can do what it takes to lead us in this difficult work, and makes clear that health care policy-making is not for the politically faint of heart. Tough, ugly work needs to be done in our state capitals; the rate of cost increases must be slowed, access to routine medical care must be universal, everyone must have health insurance, medical errors must be reduced, etc.

In addition, the pace of our efforts must be accelerated or, within 10 years, health care costs will have doubled again. There is no time to wait for all of us to become disciples of personal responsibility and turn into exercise fiends and health food nuts, and for the federal government to realize that its health care policy coma is leading us to economic ruin. There is no time to wait for kinder, gentler remedies. That means legislators have to be like moms who must occasionally put on their get-tough faces, push us to do what has to be done, and get comfortable with the fact that reforming health care is going to be one long process of repeatedly making us all madder than a just-vaccinated toddler, but for are own good.

That means legislators – and the rest of us – have to try remedies we would never have considered back when there was more time and more money. It means getting rid of preconceived and precious notions about the free market being the solution to all of our health care problems, or individual responsibility being the whole answer, or that no personal freedom can be sacrificed to prevent waste of health care dollars. Those principles are important, they have a role to play, but if they are used to the extent that they have been in the past to fence off legislative options for controlling health care costs, we will be left with a small pasture of possible solutions. That does not mean we should consider any means to the end, but will have to consider things that just a few years ago pushed our political delete buttons.

Two years ago I wrote in this column that we were all blowing smoke if we said we wanted to control health care costs but were unwilling to wear seat belts, hang up cell phones, put on motorcycle helmets, and make other sacrifices necessary to achieve that goal. Since then, health care costs have gone up about 15 percent, another million of us are uninsured, the crisis looms ever larger, and untold billions of health care dollars have been wasted. Since then, a new group of legislators has been elected, and sits in front of a pile of health care bills and related tough choices.

If they blink, or dodge tough issues, or fail to reconsider old reasons for refusing to consider some ways to solve our health care problems, we can expect more of the same: rising health care costs with no end in sight, and more million-dollar hospital bills for misery-producing freedoms our leaders should have the courage to tell us we don’t need and can no longer afford.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Health care Systems and is on the staff of several hospital emergency rooms in the region.