Somewhere between the health care extremes — no government involvement and total government control — real reform is possible. And reforming America’s health care system is one of the most pressing challenges that we face.

[IMGCAP(1)]Serious problems have emerged. Skyrocketing administrative and liability costs, cumbersome interstate restrictions and the terrible reality that our nation’s poor receive primary care at the highest point of cost — emergency rooms — necessitate a thoughtful debate and comprehensive reform.

Currently, we spend more than $2.2 trillion on health care annually and yet 45 million Americans — 38 percent of whom are small-business owners, their employees and dependents — are kept from affordable coverage because of rising costs.

Since 1965, the percentage of the federal budget allocated to Medicare and Medicaid has grown out of control. Originally estimated at an annual cost of $12 billion by 1990, Medicare actually cost a whopping $107 billion that year. Likewise, Medicaid, which originally accounted for 2.9 percent of the total national health cost, rose to 15 percent by the year 2000, and the price tag keeps rising. In fact, the Congressional Budget Office projects that together the programs could consume as much as 20 percent of gross domestic product in the next generation.

Like every Member of Congress, I’ve been searching for a responsible solution. Such a solution must protect the patient-doctor relationship and allow the freedom to choose not only competitive insurance plans, but preferred doctors as well. It must ensure timely access to quality treatment, and it must avoid a government takeover that puts the important decisions about care and treatment in the hands of Washington, D.C., bureaucrats.

The key component of President Barack Obama’s plan for change is a government-run insurance option that would provide universal coverage at a staggering cost with limited options for the poor. Under the Obama/Speaker Nancy Pelosi (D-Calif.) scheme, the uninsured and underinsured will be enrolled in a plan modeled after Medicare — a program that will be bankrupt by the year 2018. Not content with only running the American auto, banking, mortgage and insurance industries, the president is now positioning himself to be our physician in chief.

How’s this sound for reform? Take one of the most fiscally problematic and bureaucratically bloated federal programs in modern history and replicate it on a universal scale. Mix it up with an apothecary’s dose of rhetorical hallucinogens, and package it nicely with the label of change and hope that the country buys it.

The president told us during his campaign that his plan would save every American as much as $2,500 per year on their health insurance premiums, but if his ability to estimate premium savings is anything like his ability to estimate job creation, I’m afraid we’re in for another unpleasant surprise.

Yet there are some areas where both parties are finding common ground. For instance, every American should be encouraged to purchase coverage through an incentivized tax structure.

For those who are unable to purchase coverage because of limited income, however, I support a voucher system that allows them to choose from an array of private plans on the open market. Rather than automatically enrolling underprivileged Americans in a plan they didn’t choose, I suggest empowering them to make decisions for themselves and their families, aided by a direct government subsidy when necessary.

Already, the federal budget includes the cost of primary care for the poor and underprivileged through Medicaid and other federal subsidies like the State Children’s Health Insurance Program.

What they are without, however, are the kinds of choices that President Obama promised — choices that Pelosi and every Member of Congress have. The choice to evaluate a range of competitive plans and determine which one meets his or her own needs. The choice to find your own doctor and change doctors when necessary.

We can reform the system — not just expand and repackage it — if we will hold fast to three basic principles. The private sector is more efficient and less costly than the public sector. The poor are better served by choice and assistance than by coercion and exemption. And Congress has a responsibility to enact responsible reforms that address long-term problems, not hasty legislation that limits the access of all Americans to timely, affordable and dependable medical care.

Rep. Darrell Issa (R-Calif.) is the ranking member on the House Oversight and Government Reform Committee.