Coherent solutions for the problem of reducing health-care costs cannot be found within the current piecemeal system of paying these costs. The reason is that this system gives health-care providers and insurers every incentive to shift, wherever possible, the costs of treating illness onto each other or any other party, including the patient. That clearly is the lesson of the various reforms of the 1980s: push in on one part of this pliable spending balloon and an equally expensive bulge pops up elsewhere. For example, when the government health-care insurance program for the poor cut costs by disallowing payments for some visits to physicians, patients with advanced illness later presented themselves at hospital emergency rooms in increased numbers. The argument proceeds by ['employing an analogy to characterize interrelationships', 'demonstrating that cooperation is feasible by citing an instance', 'attributing without justification fraudulent intent to people', 'showing that shifting costs onto the patient contradicts the premise of health-care reimbursement']