A new report from Wellmark Blue Cross and Blue Shield of Iowa showed that the health insurance company essentially wasted $11 million last year by reimbursing Iowans and South Dakotans for expensive prescription painkillers when Advil would have worked just as well.

The strong language is my emphasis, but that’s the message I took from reading between the lines of the insurer’s latest article, the fifth in a series dedicated to helping consumers make better choices about health care in order to slow rising expenses. The effort is part of a larger campaign Wellmark has undertaken to curb health-care costs.

Spending on health care in the United States is expected to reach $2.6 trillion by 2010, up from $1.5 trillion last year, Wellmark said.

Of the $16 million that Wellmark spent on painkilling medications, $11 million went to cover the cost of three drugs: Pfizer Inc.’s Celebrex and Bextra and Merck & Co.’s Vioxx. Wellmark’s chief medical officer, Dr. Dale Andringa, said ordinary ibuprofen and aspirin would have been “equally effective for most people.”

Earlier reports from Wellmark outlined how spending on prescription drugs skyrocketed in the 1990s when drug companies figured out how to advertise.

For instance, the average annual cost for Vioxx, Celebrex and Bextra is $1,073 per patient, compared with $44 for ibuprofen, Wellmark’s report said.

The airwaves and newspapers are full of sad stories about elderly people who can’t afford their prescription medications, or are forced to choose between purchasing groceries and buying drugs that will treat their ailments.

It’s a heartbreaking choice, but at least they have the choice, compliments of the hundreds of millions of dollars that pharmaceutical companies spend each year to create and develop new medications.

What kinds of medications, I wonder, were available 50 years ago, when our great-grandparents could have used them? Criticize the profit motive all you want. The fact remains that it’s the best way we have found so far to create an incentive to develop more effective medications.

Patients ultimately bear responsibility for their own care. But I am afraid that Wellmark may be asking a little too much from its policyholders. The 800-pound gorilla in the room, in my mind, is doctors.

Drug companies are spending a great deal of money each year paying salespeople to visit doctors’ offices. They drop off free samples of prescription drugs and take doctors out for expense-account meals whenever possible. Their employers even foot the bill for weekend “conferences” at expensive resorts. These practices, though in decline, must be stopped altogether.

I don’t blame the drug companies. This is a physician problem.

Not all doctors are guilty. But as a whole, doctors bear the lion’s share of responsibility when it comes to helping hold costs down.

After all, physicians are the gatekeepers to health-care services. The public trusts them because they have to. Marketing on the part of drug companies might cause patients to ask their doctors for a certain pill, but I am willing to bet that they would retract the request for a Vioxx or Celebrex prescription if the doctor told them Advil would work just as well.