Health and budget reform as handmaidens

Meeting almost any new major federal budget priority--for children, the elderly, energy independence, budget balance, or even the uninsured--soon will be nearly impossible if health costs grow as projected. Budget-driven reforms in health policy, therefore, are almost inevitable for any president seeking to set new national priorities. Those health reforms must confront the fundamental budgetary flaw of health policy: creation of decision-making structures and incentives that look mainly to benefits while shifting costs freely to others. All players need more reliable mechanisms for making choices reasonably, albeit no longer for open-ended consumption of care or payment to providers.