We are fighting the wrong war on healthcare.

Washington keeps arguing over who should pay the bill while ignoring what’s driving costs in the first place — a policy failure decades in the making.

We have a serious problem with healthcare spending in the US. In a multi-part series in the Boston Globe, I lay out solutions that can help. Please read and feel free to weigh in.

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When doctors get the diagnosis wrong, patients pay the price. Unfortunately, that is exactly what has happened with the American health care system: Lawmakers have misdiagnosed the problem, and the American people pay the price.

For millions of working families, the cost of the misdiagnosis is obvious: Premiums and deductibles now consume so much of household income that many families delay care, drain their savings, or make difficult choices between health care, rent, and child care. Small businesses drop coverage they can no longer afford, and states divert money from schools, roads, and public safety just to keep Medicaid afloat. The United States is on track to spend more than $7.7 trillion per year by 2032. That level of spending will further erode coverage, overwhelm public budgets, and force painful tradeoffs with other essential investments.

For decades, policy makers have treated rising health care costs as an unavoidable fact of modern life — the inevitable byproduct of an aging population, rapid medical innovation, and expanded coverage. That convenient story has allowed Washington to focus almost exclusively on subsidies — how big they are and where they come from. It’s like arguing over who should pay the restaurant bill while the price of the meal keeps climbing. But if you misdiagnose the disease, you cannot prescribe the right treatment.

Some of the increase in spending does reflect genuine progress. More Americans are living longer. Breakthrough treatments are saving lives that once would have been lost. But a large share of our cost explosion is the result of deliberate policy choices — choices that tolerate extreme prices, reward wasteful care, permit unproductive consolidation, and embed extraordinary inefficiency into the delivery of care.

The misdiagnosis is not just technical. It is ideological.

On the political right, the reflex is to blame government — and these days, especially the Affordable Care Act — for health care dysfunction. That story is simplistic. US health care spending was on an unsustainable trajectory long before the ACA, and while the law successfully expanded coverage, it did little to bend the cost curve. At best, the ACA slowed spending growth in the Medicare program, but it had limited impact on spending, positive or negative, among the commercially insured.

On the political left, the instinct is to blame “the market” and corporate profiteering. That story is also simplistic. In many American communities, there have been real breakdowns in the market. Patients largely cannot shop because they have too few choices. Prices are opaque. Competition is weak or nonexistent. In too many areas of America, what we call “the market” is actually a set of government-protected monopolies sustained by policy choices that reward consolidation and shield incumbents from competition.

While both sides argue, the status quo wins. Policy makers fail to take action to address why the health care costs are so high in the first place.

When the domestic argument hits a wall, the debate turns abroad. Liberals point to Denmark or the United Kingdom, two largely publicly funded systems with few out-of-pocket costs. Conservatives point to Singapore, which relies largely on health savings accounts and catastrophic coverage with more of a functioning market. The implication is that if we would simply import someone else’s system, our problems would disappear.

My mentor and friend, the late Uwe Reinhardt — one of the world’s great health economists — used to caution against that kind of thinking. During the 2016 presidential campaign, when Bernie Sanders frequently praised the Danish health care system, someone asked Reinhardt what he thought of it.

Defending the Danish system from criticisms by those who referred to it as socialized medicine, Reinhardt is purported to have responded “I will happily take the Danish health system, but you must also give me the Danish political system … and it would surely help if you gave me the Danish people.”

His comment was both witty and deeply insightful. Health care systems are embedded in political institutions, regulatory cultures, and social expectations that cannot simply be copied and pasted. What matters is not importing someone else’s model but fixing our own — using tools that fit American institutions and American values.

The United States can lower health care costs — or at least dramatically slow their growth — without sacrificing quality or access, if policy makers choose to focus on the right levers.

Over the next eight columns in the coming months, I will lay out (sometimes writing with a colleague) a practical reform agenda that could slow health care cost growth by hundreds of billions of dollars a year without cutting benefits, rationing care, or stifling innovation. The proposals target the actual drivers that affect spending: health care market consolidation and pricing, broken payment incentives, administrative waste, unnecessarily high drug costs, workforce restrictions, site-of-care distortions, and insurance design. None of these ideas are radical. All are achievable. Some require federal action; many can be implemented by states. And nearly every one will threaten a powerful political interest — which is precisely why they matter.

The real question facing the country is no longer how to pay for an expensive health care system. It is why we continue to tolerate one that is so unnecessarily expensive — and what we are finally willing to do about it.