Gov. Ed Rendell wants to expand health insurance to 767,000 uninsured Pennsylvanians by increasing taxes on employers and tobacco users, to name just a few. The full costs have yet to be quantified, but they are sure to be underestimated from the get-go, like all other government-run health-care programs.

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Setting aside the multi-billion dollar price tag that will accompany "Cover All Pennsylvanians," expanding taxpayer-subsidized health-care insurance fails to address the reasons why people don't have insurance coverage in the first place.

First, according to the U.S. Census Bureau, there are about 517,000 uninsured Pennsylvanians between the ages of 18 and 34. Understandably, this relatively healthy demographic is neither interested nor willing to pay for an expensive insurance program that they do not intend to utilize.

Second, the reason health insurance is so pricey is because health care itself is expensive. But the high cost of health care is primarily due to the health-insurance model of how we pay for health care. Indeed, the health-insurance system bears much of the responsibility for helping create a health-care system that is expensive, inefficient, bureaucratic and error-prone.

Unfortunately for both health-care consumers and taxpayers in Pennsylvania, Gov. Rendell's solution to the problem -- subsidizing and ultimately mandating health-insurance coverage -- is not a solution at all. Indeed, such a scheme will only serve to exacerbate the problems in our health-care system.

So what is the solution? First, we need to rethink the role of health insurance. Instead of being a pre-payment plan for future health-care services we may or may not use, health-insurance coverage should be restored to the same function in our lives as home or auto insurance. We should utilize health insurance for catastrophic purposes, not daily maintenance.

Think about it. We don't purchase auto insurance to cover our oil changes or adding washer fluid. We buy it to protect us from major, unforeseen accidents. Auto owners pay for the regular upkeep and maintenance of their cars. We don't fill up with gas and send an invoice to GEICO or Progressive -- or the taxpayers. If we did, we wouldn't care about how much a tank of gas costs. Herein lies the problem.

		Matthew J. Brouillette is president and CEO of the Commonwealth Foundation, a public policy research and educational institute located in Harrisburg (mjb@ commonwealthfoundation.org).

The fact that our auto insurance doesn't operate like our health insurance is what keeps prices competitive and relatively low for basic services. It also keeps premiums for catastrophic coverage reasonable because they are adjusted to our expected claims. If you're a good driver, you get price breaks. If you're a habitual speeder, you pay more. For the most part, unlike your health insurance, your auto-insurance premium is not affected by how bad of a driver your neighbor is.

Health insurance should be designed and utilized in the same manner. But it's not. Our health insurance operates like a pre-payment plan for the medical equivalent of filling up with gas or purchasing new tires, as well as when we ruin our car in an accident. The result is that we don't pay much attention to the price of medical services. Yet this is precisely what has caused the hyper-inflation of health-care costs and, by extension, the expensive nature of basic health insurance -- which is why many people choose to go without.

If lawmakers allowed health insurance to operate in a manner similar to auto insurance (currently it can't because of government regulations, restrictions and myriad other interventions in the health-care marketplace), we would put Pennsylvanians back in the driver's seat. As direct consumers of health care, we would better control costs by better managing our basic services because we -- not some third-party, either an insurance company or taxpayers -- would pay for our simple health-care expenses. We need to think in terms of personal responsibility when considering health-insurance.

Gov. Rendell's proposal does nothing to interject these necessary incentives into our current health-care system. Under his scheme, consumers would continue to have little concern about the actual costs of medical services. And why should they? They won't have to pay the bills; someone else will.

This is why the governor's "Prescription for Pennsylvania" will fail: He is prescribing treatment for the symptom rather than the cause of the problem. Expanding insurance coverage at taxpayers' expense without first addressing the factors that are driving up health-care costs will only exacerbate our health-care problems. Under the governor's scheme, neither the cost of health care nor the cost of insurance will ever become reasonably priced for the average Pennsylvanian.

A cynic might suggest that the failure of our health-care system is precisely what Gov. Rendell hopes for in order to push for his ideal of a government-run, taxpayer-funded health-care system. Lawmakers who recognize the folly and harm of socialized health care would be wise to begin proposing and pushing for ways state government could more effectively address rising health-care costs, including:

Giving individuals the same tax benefits for purchasing health insurance as businesses;

Allowing individuals and small businesses to better pool resources to purchase private insurance;

Expanding Health Savings Accounts and access to high-deductible insurance plans;

Making health-care prices more transparent for consumers;

Permitting individuals and businesses to purchase insurance outside Pennsylvania;

Reducing insurance-coverage mandates, and

Enacting reasonable limits on lawsuit awards for noneconomic damage.

Only then will we start curing the cause of our health-care ills, rather than just treating a symptom.