The Patient Protection and Affordable Care Act is making Americans as nervous as a bunch of long-tailed cats in a room full of rocking chairs. Some are anxious about what is in the 2,000-plus page omnibus law and what implementation of PPACA will bring. Others taking a longer-term view are more concerned about what is not in the law.

If you’ve seen the wiring diagram of the law produced by the Republicans on the Joint Economic Committee, you would have to believe even the kitchen sink must be in there somewhere.

Yet other than some tinkering at the margins, the new law does little to address the systemic cost drivers that are at the heart of the real problem. It was apparently much easier to pass a bunch of insurance “reforms” – some of which were, indeed, necessary – and create an enormous new bureaucracy, which is completely unnecessary, than to deal with out-of-control costs that are financed by the big, bad, evil insurers. Why it was so difficult for the industry to make the case that health insurance is expensive because health care is expensive is still a mystery to most of us.

But the big “NIMBY” in the room isn’t a reference to the backyard-lawn-chair photo ops the president has been holding. It is the huge differential in price between our backyard and our global neighbors.

It’s football season, so let’s use knee surgery as our example. According to a recent survey by Deloitte Development, the U.S. inpatient price is $11,692. The outpatient cost for the same procedure is $4,686. That alone is instructive but not nearly as much as the average of three lowest foreign prices, including travel costs at $1,398. These foreign facilities are not shacks on the beach in Cuba, but rather are JCI-accredited hospitals.

Clearly, something is wrong in our backyard. Until we make a serious attempt at addressing the costs, we’ll be paying premiums that are even higher than we pay today and getting less for our trouble. The only difference is they won’t be called “premiums.” They’ll be called “taxes.”

Check out more blog entries from David Saltzman.