Health care costs and spending continue to be top issues for many Americans. Lawmakers in Washington continue to debate how best to reform a trillion-dollar system, while closer to home, our state legislature is also trying to figure out how to best manage costs for Missourians.

Year after year, costs continue to rise. A recent study from the Journal of the American Medical Association shows that the United States spends double what other high-income nations do on healthcare, and yet we have the lowest life expectancy. Clearly, we need to take a hard look at what factors are contributing to our growing healthcare costs.

Across Missouri, health care costs continue to be a concern for consumers and businesses alike -- something I know very well due to my work in human resources for a large restaurant chain.

There are many factors driving up costs, which means there is not just one change we need to make, but many.

Waste and fraud must be dealt with. The use of emergency services like emergency rooms and ambulances for non-emergency healthcare is a significant cost driver, and more needs to be done to curtail these behaviors.

We also need to look at ways to ensure the care being provided is the care that is actually needed, rather than wasteful over-prescribing. Every test or medication that is provided without being medically necessary adds to the bill paid by consumers.

Additionally, it is important to examine the relationship between care providers, insurers and consumers. We need everyone to have a seat at the table. Only when providers, insurers and consumers work together will real progress be made in bringing down health care costs.

There is no easy solution to these problems. We need a comprehensive and honest conversation among all stakeholders as to how we can improve our healthcare system, including the realization that a part of that solution must include personal responsibility and shared sacrifice. Without this, healthcare costs will continue to climb at an unsustainable rate, burdening consumers and employers.

State Sen. Wayne Wallingford represents the 27th District in the Missouri Senate.