When Maine’s Legislature convenes in January, its members will face lots of bills about health care, but they should focus like lasers on those initiatives that will reduce health care costs in the short term. That’s because, to paraphrase former President Bill Clinton, “It’s the costs, stupid.”

In fact, they – and we – should consider little else when it comes to health care for the immediate future, because unless those costs are brought under control, little else is possible. Those costs and a tanking economy imperil virtually every other health care initiative, and any other legislative initiative for that matter, that costs anything.

Toward this end, the first order of business should be legislative initiatives to help rein in the estimated 25 percent to 35 percent of health care spending that is either wasteful or of marginal value. The Legislature should first convene experts from around the state and country to help identify a few key steps – such as formulating a list of procedures, tests, and treatments of marginal value that would not be paid for in Maine by Medicaid or private insurers – that would help reduce unnecessary use in the next few years.

Successful efforts to reduce costs by reducing care of marginal value will require that we all bring to the “table” of health policy and legislative debate some principle or practice we are now willing to sacrifice that we were never willing to sacrifice in the past. Anyone not willing to do that should be asked to leave the table (and in these kinds of cost-cutting discussions, if you are not at the table, you are probably on the menu) and should not get anything else they want from the Legislature on their health care agenda. If we are all unwilling to make such sacrifices we are doomed to failure.

If I were in the Legislature, this would be my approach to everyone who wanted my help on a health care issue. If you are another legislator, don’t even talk to me about your idea if you are unwilling to make tough choices like banning the use of cell phones while driving in Maine. You are not serious about costs if you are not willing to restrict frivolous freedoms that waste health care dollars. Ditto Maine voters; don’t waste my time complaining about your costs if you are unwilling to make difficult sacrifices of your own to reduce costs.

If you are a doctor, don’t complain to me that your fees are being cut unless you are willing to support aggressive and widespread use of medical protocols that help avoid unnecessary testing, procedures, and treatments. Don’t look to me for support in malpractice reform either, unless you are willing to tie it to more cost-effective care on your part. Ditto hospitals on both points.

If you are a trade union in Maine, your frustrations about higher health insurance premium shares for your members will be unheard by me unless you are willing to push your members to get healthier and support measures to reduce their use of wasteful medical care. If you are a representative of consumers in these debates, the same goes for you.

If you ride a motorcycle I wouldn’t give one varoom for your growing out-of-pocket medical expenses unless you are willing to support a mandatory helmet law. If you are a person who doesn’t get a little exercise every day or who smokes, don’t talk to me about how much your pills cost until you change those unhealthful ways. If you are a business in Maine, your complaints about your health care costs will whistle through the space between my ears until you are willing to take a few steps to improve the health of your employees, support a cell phone while driving ban, etc.

As the ad for Pepsi Max says, “Wake up, people!” Maine’s economy is dying, and we are all helping to kill it with our self-serving inertia on our own roles in rapidly rising health care costs, and the statewide inertia that results. This is the legislative session in which we all must focus on health care costs, especially those costs related to medical care that’s unnecessary or of marginal value. We are running out of time and economic rope, so be part of the solution to tough decisions and sacrifice some of your own sacred cows or get the heck out of the way.

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.