Organizations and individuals touched by the reality of costly health care do not share this opinion. Most employers, for whom the purchase of employee health insurance is an expense rather than a revenue, are anxious to reduce insurance premiums (12 - 14). If premiums were lower, employers could augment employee wages, reduce consumer prices, or increase profits (15 - 16). Expanding government health expenditures create budget deficits and crowd out spending for education, police, fire, and other services (15). Rising costs increase the number of uninsured people through 3 mechanisms: Employers stop offering insurance to their employees (14,17 - 18), employees decline employer-offered health insurance because they cannot afford the employee share of the premium (19), and people are dropped from Medicaid as state governments respond to increased costs with eligibility reductions (20 - 21). For the large proportion of the population that is uninsured or underinsured, higher costs make physician visits, preventive services, and prescription drugs less affordable, particularly for poor persons, elderly patients, and those in ill health (22 - 26). When costs rise and governments reduce reimbursements, institutions serving as the safety net for the uninsured may close their doors (27). These effects of rising costs demonstrate that increased cost often means decreased access.