For the past two generations, the U.S. system of federally dominated, third-party "managed care" medicine has been on a direct trajectory toward this ignominious point.

While an embarrassed Silver State now finds itself in the national spotlight, the main engines driving degradation of health-care quality are actually national. Moreover, they have been in place, gathering increasing momentum, for a very long time.

First, a rarely publicized truth: The hidden bone fields of American medicine are already remarkably large. Consider the year-2000 study, To Err Is Human, published by the Institute of Medicine of the National Academies. Its authors reviewed U.S. hospital medical records and found that as many as 98,000 people die every year from medical errors.

Even those numbers, however, may be a substantial under-estimate: the U.S. Centers for Disease Control and Prevention (CDC) says 2 million patients contract hospital-acquired infections each year, with 90,000 of them dying as a result. In addition, there is the entire subject of medication errors. Last year the Institute of Medicine estimated, based on multiple studies, "that about one medication error occurs per patient per day in hospital care."

In that report, Preventing Medication Errors, the Institute of Medicine also returned to the subject of its earlier, groundbreaking work.

"The key messages of To Err Is Human," said the Institute, "were that there are serious problems with the quality of health care delivery; that these problems stem primarily from poor health care delivery systems, not incompetent individuals; and that solving these problems will require fundamental changes in the way care is delivered."

That American health care's problems are systemic is an argument we often hear from advocates of socialized medicine. But the rarely admitted reality is that we already have socialized medicine. And it is that system that is increasingly devolving into -- and subjecting us to -- bureaucratically indifferent, incompetent and callous Soviet-style medicine.

Michael F. Cannon, director of health-policy studies at the Cato Institute, made this point emphatically last October:

"We've already got socialized medicine. Government already pays for half of Americans' medical care. Government controls production and consumption by determining the number of physicians; what services medical professionals can offer and under what terms; where they can practice; who can open a hospital or purchase a new MRI; who can market a drug or medical device; and what kind of health insurance consumers may purchase. Government even sets the prices for half of our health-care sector directly, and indirectly sets prices for the other half."

Yes, said Cannon, "Much of the U.S. health-care sector is private. But private markets are not necessarily free markets. What matters is who controls how the resources are used. More often than not, that 'who' is government."

Consider, as an example, how federal rules operate to reduce the quality of care for certain patients. Because Medicare's price-fixing system pays only predetermined fixed sums for treatment of numerous categories of illness, the actual cost to physicians and hospitals of delivering medical care can vary enormously, depending on the patient.

The result is to effectively ration care for the poor, the old and the sick. Because the government, not the patient, controls the treatment price, the system offers big economic incentives for assembly-line medicine that ignores the actual individual needs of such patients.

Precisely such a case was recently reported in Las Vegas -- 78-year-old Duke Breuer, sent home from the Endoscopy Center of Southern Nevada, an IV needle still sticking in his arm.

The impact of the federal government's bureaucratic one-size-fits-all system goes far beyond elderly Medicare patients. Because government-paid medicine so dominates U.S. health care, most large third-party payers have, for economic reasons, also adopted its approach. Nevada and many other states, for example, use the same system in their Medicaid programs for low-income patients. Ditto for numerous private insurers' programs.

Another major way government is driving America down the road toward health-care hell is by its repeated and politically motivated exemption of the health-care industry -- medical professionals, insurers, pharmaceutical companies and hospitals -- from the competitive and accountability-producing dynamics of free markets.

Today, as special-interest rent seekers, left-wing ideologues and mentally challenged politicians agitate for a full-blown, coercive, police-state health-care socialism, it's worthwhile to stop and reflect just a moment:

If you like the growing problems America has now, you'll love the mess we'll have later.

Steven Miller is vice president for policy at the Nevada Policy Research Institute.