But think back three or four years. In fact the whole argument about extending the prescription drug benefit to Medicare would suggest that they want to extend access to more medications to more people. In one of your recent articles you disputed the common notion that higher-quality care costs less. You said higher-quality costs more, whether it is a good pair of shoes, a gourmet restaurant meal, or easy access to the best medicine. This is how markets work.
Nobody gets it.
Employers don't get it, the American people don't get it, and the typical managed care brochure reader doesn't get it. Managed care has, for years, framed this issue in its own terms, which is that low-cost HMO insurance is going to result in higher quality health care. That's a fundamental contradiction. Every rigorous academic study of the subject has shown that immunization and other preventive medical care that we provide to keep people healthy and to capture disease early on actually does cost more money in the short run. Better quality costs more and everybody knows this everywhere else in the economy.