The reason is not that people haven't heard grim warnings about thefuture. It's because they don't understand what's going on in thepresent. In 2009, the averageemployer-sponsored health-care plan cost a bit less than $13,500. Butvirtually no one cut a check for $13,500. Employers generally pay morethan 70 percent of their employees' health-care costs. To employees,that seems like a good deal, particularly given how fast costs aregrowing. A "benefit," as it's called.

But health-care coverage is not a benefit. It's a wage deduction.When premium costs go up, wages go down. When premium costs go down,wages go up. Yet workers don't know that. In fact, the information ishidden from them. That means that cost control seems like all pain andno gain, which makes it virtually impossible for Congress to pass. It'slike asking someone to diet when they don't realize it will help themlose weight.

Cost control is not, in fact, all pain and no gain. It's some pain in return for a fat raise. A 2006 study,for instance, by Harvard's Katherine Baicker and Amitabh Chandra usedmalpractice payments to estimate the effect of premium increases onwages. They found that a 10 percent increase in health-care premiums"results in an offsetting decrease in wages of 2.3 percent" and anincrease in unemployment of 1.2 percentage points. Compensation isbasically a set sum for employers, and they don't seem to care muchwhether it goes into wages or into health-care costs.

Workers saw this in the 1990s. This was the era of the managed-carerevolution, which most remember as a horrifying failure. Famously,audiences applauded when Helen Hunt broke out into a profanity-ladenrant against HMOs in the movie "As Good as It Gets." The popularbacklash was so intense that by the turn of the century themanaged-care experiment was virtually over. The problem with thishistoric failure? The data showed the experiment to be a tremendoussuccess.

From 1989 to 1995, median wages actually fell a bit. Then, managedcare kicked in. Annual growth in health-care costs fell from more than10 percent in the early 1990s to less than 5 percent in the late '90s.Meanwhile, wages shot through the roof, rising more than 11 percentfrom 1995 to 2000. Then we ended the managed-care experiment, andhealth-care costs resumed their normal speed of growth. Predictably,wages slumped back down from 2000 to 2006. "By every observableindicator," says Harvard's David Cutler, "managed care was a hugesuccess. It cut spending, cut the growth of spending and didn't seem tokill anyone. And yet everyone hated it."

Of course they hated it. They didn't see its benefits, only itscosts. They knew they were suddenly trapped in networks and beinghassled by their insurers. As for their raises, those were nice, butwhy are you changing the subject?

When Americans rejected managed care, in other words, they didn'tknow they were ending wage increases, too. But since 1990, wages havetracked changes in premiums more closely than they've tracked thegrowth of GDP. Maybe if more workers knew that, they would be moreinterested in efforts to control health-care costs.

One of the best reforms that could be made this year would be togive workers that information. So far, however, efforts have beenunsuccessful. During the Senate Finance Committee's negotiations, RonWyden (D-Ore.) offeredto give employees the option to reject their employer's offerings inreturn for a voucher that would help them choose their own insurance onexchanges, which meant they would save money if they chose cheaperplans. Much more modestly, Chuck Grassley (R-Iowa) floated an idea tosimply require employers to report their health-care spending onworkers' W-2 forms. Both were stymied by an odd-bedfellows alliance ofemployers and unions.

It's not too late, though. Perhaps the easiest way to dramatize theissue for workers would be to attach health-care costs to eachpaycheck. If employers listed the cost of health care alongside thebite taken by payroll taxes, it would be much clearer to workers thathealth-care coverage was coming out of their wages, not out of theiremployer's largess. That, at least, could help them see the costs ofthe system more clearly, which is, unfortunately, something that allthe congressional debate isn't helping anyone do.

Ezra Klein reports on domestic and economic policy for The Post. He blogs at http://washingtonpost.com/ezraklein.