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The chronically ill and those toward the end of their lives are accounting for potentially 80% of the total health care bill out there. There is going to have to be a very difficult democratic conversation that takes place. The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.

There is no decision that we can make that doesn't come with some sort of balance or sacrifice.

We are already seeing older people wanting greater choice in how, when and where they receive care.

We are thinking ahead to long-term care, aware that many folks don't plan ahead and won't be ready. We want to see to it that people will have choices.

But the rule seems to be that the bigger and more life-changing the decision, the less it will seem like a decision at all.

There should be choice in healthcare.

Regardless of the magnitude of the decision, our brains make it hard for us to keep the perspective we need to make good choices.

I think we have to be very careful when we toss around terms like 'cut health care costs.' We would do very well to expect a cut in the rate of increase.

What you see is when the government gets involved, you run out of money and health care gets rationed.

There is no question that managed care is managed cost, and the idea is that you can save a lot of money and make health care costs less if you ration it.