Bad Medicine

Sunday's front-page story in The Times on doctors who shun patients with Medicare may have been alarming enough; it seems that recent cuts in Medicare payments are inducing many doctors to avoid treating Medicare recipients at all. But this is just the beginning of a struggle that will soon dominate American politics.

Think of it as the collision between an irresistible force (the growing cost of health care) and an immovable object (the determination of America's conservative movement to downsize government). For the moment the Bush administration and its allies still won't admit that there is any conflict between their promises to retirees and their small-government ideology. But we're already past the stage where this conflict can be hidden with fudged numbers. The effort to live within unrealistically low targets for Medicare expenses has already translated into unrealistically low payments to health-care providers. And it gets worse from here.

Why do health care costs keep on rising? It's not because doctors and hospitals are greedy; it's because of medical progress. More and more conditions that once lay beyond doctors' reach can now be treated, adding years to the lives of patients and greatly increasing the quality of those years — but at ever greater expense. A triple coronary bypass does a lot more for you than a nice bedside manner, but it costs a lot more, too.