President Barack Obama and members of Congress want to change the way this nation delivers and pays for the care of the sick. Given the complexity and costs of health care, this certainly is the most ambitious political campaign of the still-new 21st century.

But the Obama administration is not short on ambition. Working with the House of Representatives, it already has taken steps to redesign the way the nation generates and uses energy. While the energy initiative, as it exists, would penalize those who mine coal and depend on it to generate electricity, it commands far less attention nationally than the ongoing health care debate, which has energized and enraged normally placid Americans. We're now in the finger-pointing, name-calling phase. Our own Sen. Jay Rockefeller is publicly flogging insurance companies. He has cast them as the bad guys. It's always handy to have someone to vilify in a public debate.

I cannot offer a detailed explanation of the pros and cons of the swirling health care proposals out there. I tend to hold a fairly narrow West Virginia view of the nation's colossal and disjointed health care system and its subtleties, intricacies and relationships.

As the son of a nurse, I learned about health care through osmosis. My mother was not shy about offering her views about health care during the time she took care of patients from the early 1940s to the mid-1980s.

For her, health care was a passion. She had watched her aunt work as a public health nurse in rural West Virginia, taking care of patients who were too poor or isolated to get to a doctor or hospital. Her aunt was her role model.

After World War II, many large employers offered generous health insurance to their workers. They wanted good people, and employers made health care a part of their employees' benefits. Workers and their families came to expect health care at no cost or low cost.

While working at a Parkersburg hospital, my mother saw health care change forever when President Lyndon Johnson and Congress established Medicare and Medicaid in 1965. She believed those new programs were game-changers -- a shift in public policy that forever altered the financial dynamics of health care delivery.

Those programs demonstrated that the federal government had a role to play in providing health care to certain populations, specifically the elderly and poor. People came to expect the government to fund and regulate health care delivery. Over time, it became the norm, a right, an accepted part of American life.

She also observed that the federal government's involvement gave health care providers more assurance that they would be paid for their services. She speculated that government's expanded role in financially supporting health care delivery would alter the way health professionals behaved.

Doctors who had made house calls in the 1950s changed their routines. Physicians remained committed to providing care, but now they had businesses to run -- scheduling, billing, referring. Medicine became more lucrative as it became more complex.

More medical technology became available, but at considerable cost. Communities built hospitals and filled them with trained professionals. Pharmaceutical companies developed new, effective and expensive medications and now advertise them, creating demand for drugs that promise to cure all sorts of ills.

Both health care providers and patients experienced seismic changes in their behavior, and those changes have driven up costs, consuming more and more of the nation's gross domestic product. According to the Kaiser Family Foundation, health care costs soared from $75 billion in 1970 -- $356 per U.S. resident and 7.2 percent of the GDP that year -- to a estimated $2.5 trillion this year, or $8,160 per U.S. resident and 17.6 percent of the nation's GDP.

The federal Centers for Medicare and Medicaid Services project that health care spending will be $4.3 trillion in 2018 -- that's $13,100 per resident and 20.3 percent of the GDP.

Against this tangled and growing web, the president and congressional leaders demand fairness from a system that never has been entirely "fair." In the meantime, highly trained physicians, nurses and other providers want to be paid. Hospitals have expenses to meet. Medical technology and drugs are costly. Insurance executives, whose companies' shareholders expect to earn money, have a critical role to play.

Considering the escalating costs of health care, I understand why many Americans want reform, but I have a difficult time believing we can change it without changing the expectations of patients and providers. Perhaps Obama and his allies have their sights set too high, trying to impose an immediate political solution to a problem that took decades to develop. Perhaps they have not made their case to the American people, who have come not to trust every government solution devised to make their lives better.

Perhaps less is better.

A friend has given some thought to the health care discussion, and his approach to health care is based in his belief in the laws of supply and demand and marketplace competition, which can reward the efficient and effective and allow patients to shop for services more prudently.

1. Train more physicians, nurses and medical technicians.

2. Require physicians and institutions to publish fee schedules so patients can shop effectively.

3. Reduce the duration of patents on drugs from 20 years to 10 years or less.

4. Cap pain and suffering and punitive damage awards in medical malpractice cases.

5. Allow states to regulate private insurance companies in much the same way they do utilities.

Again, less may be better. Making any sort of significant changes will be difficult, but starting modestly may resonate more with those who must pay the health care bill.

Dan Page is editor and publisher of The State Journal. His e-mail address is dpage@statejournal.com.