By GREGORY L. SCHNEIDER

There is little doubt that health care is a complex issue involving dozens of different players, including patients, physicians, insurance companies, hospitals, pharmacists and government. Often the patient the consumer is the least remembered.

There's been a lot of talk about public options, co-ops, mandates and pre-existing conditions but there's not been nearly enough discussion about which concept of health care is in taxpayers' best interest. There are two very different concepts from which to choose: (1) a top-down government centered model, or (2) a bottom-up reform which empowers individuals and allows them to choose the type of care and coverage best suited for them. That's it, in a nutshell.

We can and should talk about how to make health care more affordable and accessible, but first we have to decide whether we want the government or the consumer to be in charge. It's not that only one model can deal with some of the critical issues; it's about political and economic power. Do we want to give more power to government or to individual taxpayers?

Empowering the consumer to take control of their own health care spending has been the missing idea in the debate over reform. But consumer-driven reforms contain the best chance of reducing health care costs and insuring more Americans while not adding to budget deficits. Health Savings Accounts, catastrophic insurance for the young and healthy, insurance reforms which would end guaranteed issue of insurance and community rating. Tort reform would reduce the expense of combating health-related lawsuits, which may cost as much as $100 billion per year. And allowing health insurance to be sold across state lines would increase competition, possibly drive down cost and avoid interruption of coverage because of a move to another state These changes would make health reform a reality without spending taxpayer money and empower consumers.

Consumer-driven reforms would be affordable, provide accessibility for those currently without insurance, and since the insurance one purchases doesn't necessarily depend on one's job, consumer-driven health care options would also be portable.

None of these reforms are included in the plans being discussed in Washington; instead, they focus on centering power in either a government run insurance exchange which will eventually replace private health insurance, or of creating a government option based on a single payer system such as exists in Great Britain and Canada.

Government-run health care as it exists in America today is already in trouble and costs more than the private health insurance system. Medicare and Medicaid already pay doctors less for services than private insurance, the result of which is that more doctors are unwilling to take patients with Medicare and Medicaid.

The government-run argument is that the country faces a health insurance crisis. There are 45 million uninsured who either cannot afford insurance or have pre-existing conditions which prevent them from qualifying for private insurance. But every analysis of the actual uninsured numbers points to one fact: the actual number of uninsured (those who do not qualify for Medicaid, and who cannot afford private insurance) is more in the neighborhood of 5 million. Through tax credits or other means, these five million could be insured far less inexpensively than by reforming the entire health care system.

Another big weakness of the government run plans is that they would do nothing to reduce the costs of health care, as the Congressional Budget Office figures show pointedly. Instead it would add $1.7 trillion to an already overblown deficit over the next decade.

On Sept. 9, President Barack Obama will speak to Congress on health care. It will be, according to some estimates, his one hundred-eleventh such speech on the topic. It is thought that he will finally propose a plan without the government option. It would be better for health care reform if he proposed the consumer option instead and junked the other plans. It would be a nice surprise and signify a movement towards the real reforms which will actually lower costs and insure more of the uninsured.

Gregory L. Schneider is a Senior Fellow with the Flint Hills Center for Public Policy and heads the Center's Consumer-Driven Health Care Project.