Should we shrink the health care system?

As this director of a large eastern medical center has traveled about the country, talked many times on the subject of health cost management, and examined various cost-containment plans, he has come to realize that most, if not all, of those isolated programs stand little chance of more than marginal success. True cost management can come only from a hospital system shrinkage that involves loss of jobs and closings. There is no simple way out of that box, he argues, and people should begin to realize it. Whether there is the national resolve to put the lid on accelerating health costs is questionable, but at least a clear understanding of that fact and its consequences may lead to a few successful hardheaded programs and provide preventive medicine for the numerous trivial programs that no doubt will continue to spring up.