As medical bills spiral upward, the refrain is ever more common: Health care is costing an arm and a leg.

But how much does that broken arm or that shattered leg cost?

Greg Davis, whose son Jonathan fractured his right leg during football practice, confesses to having little interest in finding out.

"Until it hits my pocket, I'm really not concerned about it," said Davis, an MRI supervisor at UC Davis Medical Center. "As far as I'm concerned, my son's broken leg is costing $65: the $50 emergency room co-pay and the $15 for an office visit.

"Thank God for insurance," he added.

Partly motivated by an effort to contain costs, policymakers are considering a comprehensive overhaul of the country's health care system. But most Americans with quality insurance coverage may have little clue, or concern, about what goes into health care spending, which is expected to grow to $2.5 trillion this year.

That's nearly double the $1.4 trillion the government estimated was spent on health care in 2000 – which was already twice the $714 billion recorded just 10 years earlier.

By 2018, the nation's tab for health care is expected to surge to $4.4 trillion, according to the National Coalition on Health Care.

As the health care reform movement goes into high gear, there is little question that escalating cost is the major factor driving the effort. But there is wide debate about whether health care legislation will reduce health care costs.

Glenn Melnick, an expert in health economics and finances at the University of Southern California, said the proposed plans contain vague notions of improving efficiency and increasing competition. But there's no guarantee that a government-run insurance plan or other overhaul proposals will bring costs down, he noted.

Much of the discussion over rising health care costs has centered on rising insurance premiums, with consumers and employers bemoaning their increasing financial burdens.

A host of factors have contributed to the rising costs, including fear of malpractice lawsuits, expensive new technology and drugs, and high administrative costs for private insurers.

"The rate of health care premiums follows the increase in medical costs," said Patrick Johnston, president of the California Association of Health Plans. "Health premiums are just reflecting the underlying medical costs in our system. Until we address those, we can't achieve sustainable health care coverage in this country."

One authority, the federal Centers for Disease Control and Prevention, says the main reason for the rising cost of health care – the culprit in 75 percent of all medical expenses – is the general health decline of a U.S. population that increasingly suffers from chronic conditions such as diabetes, cancer and heart disease.

Yet consumer ignorance of the true cost of care is also part of the problem, say many who have studied the issue.

"By and large, most people have no idea how much medical care costs, and they're not used to paying for it," said USC's Melnick.

Jan Emerson of the California Hospital Association offered a similar view. "American consumers are used to getting whatever health care service they need, when they need it, and don't ask about the cost," Emerson said. "If we're really going to change the system, people are going to have to care."

Consumers demanding costly services, therapies or the latest name-brand drugs help push up expenses, said Dr. Dev GnanaDev, president of the California Medical Association.

"Patients see ads, go to their doctors and demand they get what's advertised. A doctor might resist for a while and put them on cheaper generic drugs, for example, but you can't always succeed all the time. Patients sometimes hound you," GnanaDev said.

In recent years, consumers have become more aware of the rising cost of health care. Millions have lost their insurance, or have been required to pay higher premiums or deductibles. This trend has spurred calls for relief.

"Only in the last several years have they seen some of the cost being passed on to them," Melnick said. "It's been a bit of a sticker shock, because they've mostly been shielded from it."

Call The Bee's Bobby Caina Calvan, (916) 321-1067.