If I walk into a Lexus dealership (well, yes, they probably would assume I was looking for directions, but work with me here) and ask how much for the new Lexus SC, at some point I'd expect to hear a number and I'd know that, generally anyway, that number relates to quality. What I wouldn't expect to hear would be a litany of how much it costs to design and manufacture a Lexus, how a Lexus dealership costs more to run than a Chevy shop, how a Lexus costs more in one part of the country than another, and so on. Nor would the dealer be likely to suffer my limited budget woes and the idea that he should take less, because, well, Chevy dealers have to make a living too.

Then there's medicine. Pharmaceutical companies reflexively cite monumental R&D costs to justify what appear to the user to be runaway prescription costs. Washington lobbyists twist themselves into pretzels trying to educate government payers that, beyond what it costs to provide a service, they should give some consideration to the benefit that the patient derives.

This month, I intended to try to point readers to our new series, The First Five Years, when several things hit my radar that diverted my attention. One of them is an article in The New England Journal.1 The authors clearly and convincingly point out the background, flaws and challenges in correcting the through-the-looking-glass Sustainable Growth Rate and resource-based relative value scale that determine Medicare reimbursement rates. The second was a letter from the Academy of Ophthalmology (and some 50 other medical groups) to Congress with proposals to replace the SGR and promote health-care quality. (Visit aao.org.) The third was report from MedPAC, the Medicare Payment Advisory Commission, with an even more extensive look at the SGR and what should replace it. (Visit medpac.gov.)

So, those were going to push the First Five Years mention to the back burner. Then I realized, who more urgently needs to understand the system that's going to provide their livelihood for the next 35 years than new ophthalmologists, the poor generation that's going to have deal with the Perfect Storm of out-of-control medical costs and baby boomers shifting en masse from Medicare contributors to Medicare users?

So, enjoy our new series, you bright-eyed new service providers. Learn all the lessons that your generous elders are sharing about how to go out and afford that new Lexus. Then sit down and read what's going on in Washington. Get involved may be too much to ask for right now. We'll start with get informed.


1. Ginsburg PB, Berenson RA.Revising Medicare"s physician fee schedule--much activity, little change. N Engl J Med. 2007 Mar 22;356(12):1201-3.