In the rush to contain health-care costs, the response of health plans has been to raise costs for pharmaceuticals.

People enjoying the fruits of improved health care aren't the people paying for it.

This technology is valuable because it will improve health and extend lives. But we need to begin thinking about how to pay for it.

The dirty little secret of public health finance is that cigarettes are a very cost-effective killer. Living longer is great for society but a disaster for government programs.

[Another question is how to change incentives for developing the technologies in the first place.] In the automotive and consumer-electronics industries, there are incentives to develop good, cheap DVD players or good, cheap cars, ... When it comes to medical technology, there is no incentive to develop something that's pretty good but less expensive because the people who are buying it don't pay for it. It's not surprising that everyone wants a Cadillac instead of a Hyundai.

That's true even for people with chronic illnesses like asthma, diabetes and heart conditions. When people have to pay more, they are less likely to adhere to their regimen.