Cutting waste by making rules: promises, pitfalls, and realistic prospects.

American medical costs, one hardly needs to say, continue to rise relentlessly. In 1990, health expenditures consumed approximately 12.2% of America's GNP.1 A decade earlier, the share was 9.1%.2 In 1970, we spent approximately 7.4%.3 There has developed an apparent consensus-among government, labor, and profession leaders-that costs must be contained. At the same time, there is widespread agreement that access must be universalized. As a result, many believe that excruciatingly hard choices are unavoidable. This perceived dilemma has led to a great deal of talk about rationing.4 The tenor of the commentary indicates that it is a