Perspective:

US policymakers have begun to realize the need to weigh health care’s benefits against its costs if our country is to avert fiscal ruin. That costs must be counted against benefits is common sense in other domains and among health policy professionals. But it’s detested in public discussion of medical care. To silence talk of tradeoffs, politicians invoke the ‘R word’—rationing. The R word’s power to stop conversation reflects the popular belief that cost should be no object at the bedside. Reality is that any budget deal that doesn’t reckon with medical costs would be fanciful. Medicare and Medicaid are the main drivers behind nightmarish long-term deficit projections, and US health spending is on track to reach more than one fourth of the gross domestic product by 2035. Democrats and Republicans must come together to tell Americans that we can’t afford all the things that medicine can achieve, and that we must make painful choices between health care and other needs. Unless we can do so, without wielding the ‘R word’ against leaders who speak frankly about these choices, serious cost control will not be possible.