Abstract
In a health care world of negotiated budgets and cost-based reimbursement, it was important for those who paid the bills to focus on the individual cost items that were presented for reimbursement. This is the type of world that existed when Medicare was established in 1965, and it exists today in most of the government-administered systems of Europe and Canada. When Medicare was being implemented, the pundits of the day argued that only by paying “true costs” could the government prevent unnecessary profits and control total Medicare spending. How wrong they were!Congress, concerned about growing costs, attempted various reforms . . .