With a stimulus package done, health care should be next for President Obama. Opponents of so-called socialized medicine would have a better case if the current system was working, but clearly it is not.

As it stands, health care is a budget-buster from the federal to the personal level.

Big business:

Look at the negotiations between General Motors and its unions, which broke down over the weekend because the companies can't afford to keep providing, dare we say, Cadillac benefits — largely health care — to their retirees and the unions have no intention of discarding their older workers, and nor should they.

Those so-called "legacy costs" add $7 per hour or a bit more than 11 percent to the total wage and benefits package for GM, typical of the Detroit automakers formerly known as the Big Three. The problem is that in order to keep a domestic auto industry functioning, the feds are having to bail out the companies. If the bailout fails, the companies will fail and the cost of paying all those pension benefits will fall to the feds anyway, through the Pension Benefit Guaranty Corp., established some 25 years ago to ensure retirees in exactly this position. The corporation, unfortunately, is already way in the red from the failure of the airlines last decade, among others.

State government:

Medicaid and Medicare costs are ruining state budgets because the federal government isn't paying the full freight on those programs, and filling the gap between income and expenses on those programs is ruinously expensive for little states like Vermont, where Gov. James Douglas has named it a budget priority, and big states like California, where $11 billion in stimulus funding won't cover the Medicaid gap over the next two years.

Small business:

Spiraling health care costs are just another blow for businesses already reeling from the recession; for many, they will prove to be a knockout punch, or the businesses will be forced to cut health benefits for employees. Among the biggest cost drivers for health care are private plans, mostly employer-provided, picking up the tab for those whose benefits don't cover the costs (Medicare, Medicaid) and those without insurance. As employers drop employees from coverage, lay off employees or simply go out of business, there will be more and more uninsured, shifting an even larger portion of the costs onto fewer and fewer privately insured workers.

Individuals:

For those who are self-insured, partly insured or uninsured, the costs are even higher. Medical costs from emergencies are among the chief causes of personal bankruptcies in this country. Those without adequate coverage also seldom get preventative care, meaning they don't take relatively low-cost steps in advance that might prevent major problems later on. So instead of a daily aspirin, they get emergency bypass surgery. And if they can't pay, even after a bankruptcy, we all share in the cost.

It's an astoundingly inefficient system, buttressed by the few winners: Big pharma, the insurance companies, doctors in medical specialties that pay well and those rich enough to be able to pay whatever premiums and extra costs necessary to get the best care regardless of need.

The fact is, Americans pay far more for health care than any of the other developed countries, and get worse results on every quantifiable measure from infant mortality through average life expectancy.

We can't afford to be bullied by the "socialism" scare tactics any longer. Even small businesses and groups like chambers of commerce that have traditionally been opposed to a single-payer plan are starting to advocate for some reform, as they are forced to shoulder more and more costs. After all, GM is getting government help paying its health bill, so why shouldn't the local used-car dealer get the same assistance?

In the face of a full-out blitz against any reform from Big Pharma and its allies, Obama needs to get the best possible person into the Department of Health and Human Services cabinet post, now, and needs to reform our health care system, before we're all on Medicaid.