An interesting news report (see here) on Kaiser Health News gives an indication of why health reform that affects costs will be very difficult. The story details the fight in one New Jersey town over building a new hospital. As the article sets out, New Jersey is already one of the very most expensive medical care states, and residents apparently receive a lot of unneeded services. People in the affected town want a hospital right there, as opposed to having to travel a few short miles away. New Jersey probably has enough hospitals and other medical care facilities and research suggests that more providers means more care, whether needed or not, so allowing a new hospital to be built likely means higher health costs. The institution that wants to build the new hospital is a very profitable “not-for-profit”, but wants this new hospital to be an explicit for-profit facility. Not a likely recipe for lower costs. What the article most reflects is the unwillingness of most Americans to make trade-offs when it comes to health. The same people in this town who want immediate access to locally-based care, regardless of cost, are unlikely to want to either pay the costs themselves directly or through higher taxes. As long as that attitude prevails, it will be very hard to limit costs or rationalize capacity and care delivery.