I have waited for a lot of things to explode in my lifetime – spray paint cans in a bonfire, cow pies with firecrackers in them – and my wife, when I have lit her very long fuse one too many times, just to name a few. The thing I am still waiting to explode is the American public over the issue of rising health care costs.

It’s not as though there is no fuse and no bomb. In opinion polls, Americans repeatedly cite rising health care costs as one of their main concerns. No wonder. According to a report of the President’s Council of Economic Advisers in 2007, the increasing cost of health care has resulted in essentially no real increase in income for Americans employed in private, nonagricultural business (which is most of us) for the past 30 years because every time pay goes up, the increase gets eaten by higher health care costs.

Here we are, a country that gets worked up over Vanity Fair magazine photos of a 15-year-old singing star without much clothing, and we accept 30 years without growth in real income as though it was just a little flatulence in church from the pew in front of us (unpleasant but to be suffered with quiet dignity). As my kids would ask, what is up with that?

I keep thinking the next election will be the one where Americans light their torches and mass at the political castles demanding that our leaders bring these costs under control. Then I see both John McCain and Barack Obama soothing their supporters with proposals that seek to insure more Americans while ignoring the fact there is no insuring Americans for long if we don’t get costs under control, and I know we are in for more political bag balm when what we really need is brain surgery. That has been the case for 25 years.

A recent article in the Journal of the American Medical Association entitled “Who Really Pays for Health Care? The Myth of ‘Shared Responsibility” suggested to me a reason why Americans are allowing their leaders to fiddle while our economy burns on a bonfire of rising health care costs: We think most of these costs are borne largely by employers and government because those are the two sources of health insurance.

The reality is that American consumers and taxpayers are the Saudi Arabia of health care money, a vast reserve that gets drilled for more cash every time medical costs increase for American business and government. Every additional penny spent on health care in America comes from consumers and taxpayers, through higher taxes, lower pay raises, higher health insurance co-payments and higher prices for consumer goods.

Another reason many of us do little but complain about these costs is that we are uncertain what we can do about them. Solutions to the problem are so complex even experts cannot agree on them. Moreover, the health care constituents – politicians, doctors, malpractice lawyers, hospitals, businesses, health insurance companies, patient advocacy groups, etc. – all point at each other as the cause of the problem, and rarely act together to point our way out of the problem. That leaves the typical American feeling uncertain where to turn for the answers and whose castle to burn down.

Instead of giving up, we need to turn to our elected leaders and apply absolutely unrelenting pressure on them to insure us all and rein in the costs of doing so. Those leaders must be the main focus of our efforts because only our elected government ultimately has what it takes to herd the healthcare constituency cats to the table of collective solutions. Only voters can prop up politicians to take on the political clout of those constituencies and force the sacrifices each will have to make to dig us out of this collective mess. Only when we support our leaders in these tough fights will they also tell us the sacrifices we must make if we want affordable healthcare.

American incomes will essentially be flat for as long as our health care costs continue to increase at the present pace. In the meantime other costs will rise, and we will be poorer. I am waiting for the explosion.

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