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"It's Health Care Costs, Stupid"

Ezekiel J. Emanuel, MD, PhD

JAMA. 2008;299(8):947-949.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

According to recent polls, many Americans consider health care reform the No. 1 domestic issue.¹ Presidential candidates, other politicians, health policy experts, labor leaders, business groups, and others have responded with numerous reform proposals. And somehow in the clamoring, health care reform has become equated exclusively with expanding coverage to the 47 million uninsured Americans.

This is a mistake. As serious as it is, the problems of the uninsured and lack of coverage are symptoms, not the underlying problem. Focusing on them is like treating a fever without addressing the causal infection. Instead, the diagnosis and treatment need to focus on health care costs. The fundamental problem arises because of a cost-coverage trade-off. Without controlling health care costs, any attempt at universal coverage will be transient. Sustainable expansion of coverage to all Americans requires credible changes in the rate of health care inflation—the slope of . . . [Full Text of this Article]

Health Care Cost-Coverage Trade-off

Author Affiliation: Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland.

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