Health Care Expenditures Reexamined

Concern about health care expenditures is not a newphenomenon. Seventy-five years ago, President Her-bert Hoover appointed a committee to investigate the cost of medical care under the chairmanship of Ray Lyman Wilbur, MD, president of Stanford University (1). Thirty-eight years ago, John Gardner, Secretary of Health, Edu-cation, and Welfare, convened a national conference on medical care costs (2). Since then, not a year has passed without professional and lay periodicals addressing this subject. Most recently, Annals has published 4 articles by Thomas Bodenheimer on health care costs, the last of which, coauthored by Alicia Fernandez, appears in this is-sue (3–6). These articles provide valuable background ma-terial and address several key questions about expenditures from many different perspectives. Possible approaches to cost containment are discussed, with special emphasis o