Over the past year, the New York Times ran a series of articles - almost exposes, really - examining the commonly exorbitant costs of health care called Paying Til it Hurts. Every corporate executive worried about the high costs medical care - to the employee, to the employer, and to the economy - should read it. The most recent segment, How the High Costs of Medical Care is Affecting Americans, offers a “snapshot of the American experience with the cost of medical care.”

Among the findings of the report, we noted that:

• The affordability of basic medical care has created significantly greater hardships for families, even in just the twelve months. More people may now have insurance but fewer people are finding care affordable.

• One major reason for this increased burden is that co-pays are being replaced by requirements that patients contribute a percentage of charges, which often ends up costing them far more.

• As several recent studies have now reported, high deductible, “consumer driven” plans are causing people to defer or even forgo needed care.

• New solutions are needed but what those are isn’t clear to most observers.

Not to be arrogant, we think the solutions should be much clearer than they are. They will be rooted in two perspectives.

1. The poor value proposition of health care has both demand and a supply side dimension. Addressing demand through benefit design alone will not solve the problem and, as we’ve seen, can actually make it worse. It simply shifts costs, risk, or both to employees who cannot address the supply side issues - even if they were better equipped to be consumers.

2. Like it or not, employers are the payers (not insurers and certainly not consultants) and, as such, it is employers who must change the value proposition by changing their health care market - locally. Markets can be changed but no employer can do so alone. Employers must work together at the community level for the entire community if they are to change it for themselves.

The bottom line: Neither the government, the insurance industry, nor an cadre of consultants is going to solve your problem with the high costs of medical care. Employers who want solutions to the poor value of what they are paying so dearly for must become community activists.