Health care in the U.S. is a road wreck, strewn with failing government programs and an increasing number of uninsured citizens.

Like a group of well-intentioned but befuddled gawkers at the site of the crash, Congress has been debating health care for a decade without figuring out what to do.

With Mike Leavitt's confirmation as President Bush's new health czar, he will soon have enormous power to drive reform.

As secretary of the $550 billion, 66,000-employee Department of Health and Human Services, Leavitt will run the Food and Drug Administration, Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention and the National Institutes of Health.

Leavitt has a historic opportunity. Here's what he should do:

Food and Drug Administration.
The FDA needs emergency care. The organization responsible for making sure our food and medicine won't harm us has been without a chief for nearly a year.

During Leavitt's confirmation hearings, senators rightly urged that he appoint a commissioner as soon as possible. That person will have pressing issues to address.

We need an accelerated drug approval process. It costs a pharmaceutical company an extraordinary amount to bring a single new drug to market -- estimates range from $802 million to $1.7 billion.

But despite a steady increase in research and development spending, the rate of failure for new drugs is increasing too. Almost 50% of applications are failing in late-stage trials.

More drugs should be weeded out earlier in the testing process, thus limiting companies' losses. Meanwhile, drugs that clear the first testing phases should face a smoother route to approval.

Right now, the FDA bottleneck contributes to the high cost of research and development. That cost causes drug companies to focus on medicines with the potential to become blockbusters. The task of developing riskier breakthrough products is sacrificed.

If the new Health and Human Services secretary can reduce review times for new pharmaceuticals, he can turn that FDA bottleneck into an open road. That will ultimately bring down drug costs and get more life-saving medicines to market.

Medicare and Medicaid reform.
The programs that help low-income and elderly citizens also need major surgery. Medicaid spending grew by about one-third from 2000 to 2003 as economic woes made more people eligible.

Bush has suggested transforming the federal money now spent on Medicaid into block grants to states, to let local authorities target help where it's most needed. He's also proposed Medicaid spending caps. Leavitt will be charged with shepherding these controversial reform proposals into law.

On the Medicare front, Leavitt must phase in expanded prescription-medicine coverage for elderly Americans as part of a reform bill passed in 2003. While widely welcomed, implementing this $534 billion program will be a huge logistical task. So far only 6 million seniors, or about 41% of those eligible, have registered for the benefit.

Health Savings Accounts.
Another issue on which Leavitt should tow the country forward is in the adoption of health savings accounts, the child of the 2003 Medicare overhaul legislation.

An HSA is a tax-free savings account that can be spent on medical expenses and rolled over from year to year. All HSA holders must purchase a low-premium, high-deductible insurance policy designed for true emergencies. The result is an affordable, yet comprehensive, insurance/savings package that maximizes consumer choice by side-stepping the middleman bureaucracy that plagues HMOs.

Leavitt should publicize HSAs and also work to make insurance premiums for HSA holders fully tax-deductible.

Insurance.
A related challenge will be opening the health insurance market to greater competition across state lines. Now, premiums are astronomical in some states but not others because it's illegal to shop out of state. That means that a family of four in New Jersey must pay $1,000 a month for a policy that a family in Pennsylvania could get for $300 a month.

In effect, we've let state legislatures create local monopolies on health insurance. It's time to bust up these fiefdoms and let a national health insurance market develop.

Medical Malpractice Reform.
Finally, Leavitt should fix the pothole of medical malpractice lawsuits, which have been driving up health costs for years.

From 1975 to 2002, the price doctors pay for malpractice insurance increased by four times the rate of inflation. In 2002, malpractice costs were $25 billion, or $250 per American household.

The solution to this problem, which according to the American Medical Association is acute in 19 states, is simple: Cap noneconomic damages -- damages that a person can collect in addition to lost wages and other costs directly related to a malpractice incident.

California did just that in 1975. As a result, the state's malpractice insurance premiums have increased at one-third of the rate of the national average.

Leavitt, a former governor of Utah and head of the U.S. Environmental Protection Agency, will face plenty of speed bumps as he steers the American health care system toward repair. But the road map is clear: Free up the markets for insurance, drugs and medical care, and put consumers in the driver's seat.