Dr. Mike Walden, North Carolina Cooperative Extension economist in the College of Agriculture and Life Sciences at N.C. State University, responds:

"There are three goals that advocates of change cite. First, they want to make the system more accessible, that is, have more people covered. Secondly, they want to improve the quality of care. And thirdly, they want to reduce costs. The problem is it's going to be a challenge to do all three. For example, if you increase access and improve quality, especially if consumers are shielded from price, simple economics says that you're going to see usage go up. And of course, with increased usage, that implies higher not lower costs. The one wild card here is what some claim to be massive waste in the system. If you're able to find this waste and eliminate it, then you potentially could meet all three objectives. The big problem, though, is identifying what kinds of health care costs are wastes. Many doctors will order tests and procedures simply to help them with a diagnosis. It may not show up as improving the quality of care, but that helps the doctor eliminate perhaps some other explanations for the problem. So changing health care to meet all three of these objectives is going to be a very, very tall order."