Waste not, want not. This phrase is typically credited to Ben Franklin, but its profoundness was evident throughout the PMRG meeting in Las Vegas in March. This adage was the theme of two “main tent” presentations.  
The first presentation was offered up brilliantly and eloquently by keynote speaker Jeffrey C. Bauer, PhD. While the US is used to seeing double-digit annual increases in the cost of healthcare, to the point where it is now 17% of gross domestic product, we have hit the place where neither of the usual saviors—government nor employers—is able to bail us out, said Dr. Bauer. The costs are simply too high, the federal government is spending its money on other things, the states are increasingly strapped by Medicaid payments and picking up where the feds left off, and businesses are supporting the benefits of too many retirees on dwindling, recession-constrained profitability.    
We need to cut waste in healthcare expenses, which can be done while still providing higher quality healthcare by becoming more effective and efficient, he said. 
I picked up where Dr. Bauer left off in a presentation that offered data drawn from surveys indicating that while not yet a tsunami, a trend is developing that shows people are reacting to the increasing cost of healthcare by not going to the doctor unless absolutely necessary, failing to get prescriptions filled, stopping medications or taking less than the prescribed dosage.  
Put the thrust of Dr. Bauer’s presentation together with mine, and you come out with a fairly clear indication that the way medicine is practiced and paid for will need to fundamentally change if the whole system is to avoid breaking down.  
Richard Vanderveer is CEO of GfK Healthcare