By Marsha Mercer

WASHINGTON - It sounds like consumerism on steroids, but President Bush wants Americans to comparison shop for medical treatment the way they do for a new car.

"You know, when you go out and purchase an automobile, somebody doesn't pay the bill for you. You pay it," Bush said in Connecticut last week. "And you tend to shop, and you look, and you try to find out what's best for you."

Sticker shock in health care could go a long way toward lowering prices, the president believes. I can't wait for the Presidents' Day sales.

In Massachusetts, consumers soon may be buying health insurance as routinely as they do car insurance. Cue the TV ads with adorable talking lizards.

But this is no joke: Spiraling medical costs and the growing ranks of the uninsured are forcing us to rethink the way we approach health care. Facing ever-rising costs, more companies are dropping their health-insurance plans. Nearly 46 million Americans lacked health insurance in 2004, the latest year for which the census has figures.

Health-care reform could be a hot-button presidential campaign issue in 2008 - especially after last week.

The Massachusetts legislature passed a bill that would make health insurance nearly universal. Those who could afford it would be required to buy it, just as many states now require auto insurance. Those who can't afford it would get help from the state. All residents would be required to have coverage by July 1, 2007.

Gov. Mitt Romney, a Republican who is weighing a presidential bid, told The New York Times, "This proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover."

The states - and the politicians - are watching how the law plays out.

In Connecticut last week, President Bush took a different tack. He said consumers have an unrealistic idea of how much health care costs. He blamed third-party payers - Medicare, Medicaid, managed-care plans and insurance companies - for shielding people from the truth.

Bush says if people had to pay for their own care, they'd make better choices. He wants to encourage people to buy high-deductible, catastrophic health savings account policies with tax-free money. Individuals would get the same tax benefits for out-of-pocket health spending that employers now receive.

"I believe that the more the consumer is involved in pricing, the more the consumer is involved in the decision-making, the more likely it is people will start making rational decisions for their own needs," Bush said.

Critics say that Bush's plan benefits the wealthy and may encourage more companies to drop insurance coverage.

A first step toward consumer involvement will come this summer when www.medicare.gov starts listing the rates Medicare and other programs pay for common medical procedures. The president wants health-care providers to disclose their prices.

Soon, we may see a menu of charges in the doctor's office the way we see prices at McDonald's. I'm thinking super-sized surgeries. You want a tummy tuck with that by-pass?

Comparison shopping is fine in theory. In real life, though, physicians are swamped; their offices are patient-moving express lanes. It's hard to make an appointment, let alone check the price of a hip replacement.

Someone should calculate the loss of productivity as American workers search for the best medical deals.

Bush cites Lasik eye surgery, which is not covered by most insurance plans, as an example of how the market can lower price. When consumers shopped around, Lasik prices fell dramatically, he says.

Still, the president seems to think people have a lot of time on their hands, that they have hours to scour the Internet for the best price on that hernia operation or hysterectomy.

To be sure, it may be true that if the patients knew the true costs of getting well, they'd try to live a healthier lifestyle to avoid getting sick.

But people who take care of themselves also get sick. They do get in accidents. And when that happens to a loved one, we don't want the cheapest. We want the best.

People wanting a cheap, fuel-efficient car in the 1970s bought the Chevy Vega, which many now consider the worst car ever made. That's no model for health-care reform.

• Marsha Mercer can be reached at mmercer@mediageneral.com

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