This week, a report from the Congressional Budget Office tells us that if Senator Kennedy’s health care plan were to be implemented, 16 million Americans might still be uninsured even after the nation spent $1 trillion for a package meant to deliver universal coverage.

CBO budget director Douglas Elmendorf told USA Today, “It’s going to be a long, hard slog” to find savings in U.S. health delivery without “harming health.”

Here are some areas to consider…without harming health…

1. Administrative waste costs. Estimates for the cost of paper and inefficiency reach as high as 30% of U.S. health costs. Check out the U.S. Health Efficiency Index to learn more about this wasteful spending. Here’s an area where real savings can be achieved to be re-allocated to health care and away from unhealthy paper. I wrote a lot more about this cost in Health Populi in How to find $150 billion for health care in February 2009.

2. Unstandardized, and often too much, care. Can you spell “D-A-R-T-M-O-U-T-H?” The Dartmouth Atlas of Health Care has shown in brilliant detail, for over two decades, the expensive phenomenon of regional variation in U.S. health care. Move Americans to evidence-based care. Get people the right care at the right time — but just enough of it. Read Shannon Brownlee’s book Overtreated to learn more about how we supersize health care portions in the U.S. — to the detriment of quality and human outcomes.

3. Launch a national war on diabetes. If we attack diabetes as a national threat to the economy, we could make a dent in the $218 billion spend on the disease each year. There are real savings to be had in laser-focusing on this epidemic, which is growing in very young Americans and poorly managed in the middle aged and older. The death rate from diabetes is on the rise. That’s a cost that’s too dear.

Health Populi’s Hot Points: Costs are clearly in the eye of the beholder/health stakeholder. But the larger cost of not moving on health reform will jeopardize the financial health of the nation sooner rather than later — which will further deteriorate the nation’s global competitive position for business, and quality of life for citizens.

A long slog is surely ahead of us. Those stakeholders who keep their eye on the long-term goal of universal coverage, cost containment, and evidence-based care will be the heroes of health reform.

But the difficult journey will be longer and more painful if we don’t address the long-term threat of health costs to American citizens during this current window of opportunity.