title: Making cuts to Medicare: the views of patients, physicians, and the public.
abstract: OBJECTIVE
  Cancer-related expenditures are increasing health care costs. Determining how patients with cancer, oncologists, and the general public view Medicare spending and whether they would support cost-containment measures is important to identifying acceptable approaches to reducing health care expenditures.
  
  
  METHODS
  Patients with cancer treated at an academic medical center, a random national sample of oncologists, and the general public were surveyed between July 2012 and March 2013 about causes of high health care costs and proposed cost-control measures.
  
  
  RESULTS
  Three hundred twenty-six patients (response rate, 72%), 250 oncologists (response rate, 55%), and 891 members of the general public (response rate, 50%) completed surveys. The majority thought Medicare spending was a moderate or big problem (75.8% of patients; 97.2% of oncologists; 75.3% of the general public) and thought Medicare could spend less without causing harm (65.6% of patients; 74.0% of oncologists; 69.7% of the general public). There was broad consensus that drug and insurance companies' profits added to costs, although physicians, hospitals, and patients were also perceived as sharing responsibility. More than 75% of respondents supported enabling Medicare to refuse reimbursement for more expensive treatment if less costly, equally effective treatment was available. Respondents generally favored means testing Medicare cost sharing but, except for oncologists, resisted the idea of an independent oversight panel. All groups opposed annual ceilings on Medicare spending per patient.
  
  
  CONCLUSIONS
  The majority of respondents view Medicare costs as a substantial problem and that all players in the system, including providers, contribute to high costs. Most thought Medicare could spend less without causing harm. Overall, respondents strongly favored not paying for more expensive treatments when cheaper ones are equally effective.
authors.affiliation: Keerthi Gogineni, Abramson Cancer Center, Hospital of the University of Pennsylvania, University of Pennsylvania; Katherine Shuman, Derek Chinn, Anita Weber, and Ezekiel J. Emanuel, Perelman School of Medicine, University of Pennsylvania; Ezekiel J. Emanuel, Wharton School, University of Pennsylvania, Philadelphia, PA; and Carol Cosenza and Mary Ellen Colten, Center for Survey Research, University of Massachusetts, Boston, MA. kgogineni1@gmail.com.
authors.forename: Keerthi
authors.initials: K
authors.lastname: Gogineni
authors.affiliation: Keerthi Gogineni, Abramson Cancer Center, Hospital of the University of Pennsylvania, University of Pennsylvania; Katherine Shuman, Derek Chinn, Anita Weber, and Ezekiel J. Emanuel, Perelman School of Medicine, University of Pennsylvania; Ezekiel J. Emanuel, Wharton School, University of Pennsylvania, Philadelphia, PA; and Carol Cosenza and Mary Ellen Colten, Center for Survey Research, University of Massachusetts, Boston, MA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Shuman
authors.affiliation: Keerthi Gogineni, Abramson Cancer Center, Hospital of the University of Pennsylvania, University of Pennsylvania; Katherine Shuman, Derek Chinn, Anita Weber, and Ezekiel J. Emanuel, Perelman School of Medicine, University of Pennsylvania; Ezekiel J. Emanuel, Wharton School, University of Pennsylvania, Philadelphia, PA; and Carol Cosenza and Mary Ellen Colten, Center for Survey Research, University of Massachusetts, Boston, MA.
authors.forename: Derek
authors.initials: D
authors.lastname: Chinn
authors.affiliation: Keerthi Gogineni, Abramson Cancer Center, Hospital of the University of Pennsylvania, University of Pennsylvania; Katherine Shuman, Derek Chinn, Anita Weber, and Ezekiel J. Emanuel, Perelman School of Medicine, University of Pennsylvania; Ezekiel J. Emanuel, Wharton School, University of Pennsylvania, Philadelphia, PA; and Carol Cosenza and Mary Ellen Colten, Center for Survey Research, University of Massachusetts, Boston, MA.
authors.forename: Anita
authors.initials: A
authors.lastname: Weber
authors.affiliation: Keerthi Gogineni, Abramson Cancer Center, Hospital of the University of Pennsylvania, University of Pennsylvania; Katherine Shuman, Derek Chinn, Anita Weber, and Ezekiel J. Emanuel, Perelman School of Medicine, University of Pennsylvania; Ezekiel J. Emanuel, Wharton School, University of Pennsylvania, Philadelphia, PA; and Carol Cosenza and Mary Ellen Colten, Center for Survey Research, University of Massachusetts, Boston, MA.
authors.forename: Carol
authors.initials: C
authors.lastname: Cosenza
authors.affiliation: Keerthi Gogineni, Abramson Cancer Center, Hospital of the University of Pennsylvania, University of Pennsylvania; Katherine Shuman, Derek Chinn, Anita Weber, and Ezekiel J. Emanuel, Perelman School of Medicine, University of Pennsylvania; Ezekiel J. Emanuel, Wharton School, University of Pennsylvania, Philadelphia, PA; and Carol Cosenza and Mary Ellen Colten, Center for Survey Research, University of Massachusetts, Boston, MA.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Colten
authors.affiliation: Keerthi Gogineni, Abramson Cancer Center, Hospital of the University of Pennsylvania, University of Pennsylvania; Katherine Shuman, Derek Chinn, Anita Weber, and Ezekiel J. Emanuel, Perelman School of Medicine, University of Pennsylvania; Ezekiel J. Emanuel, Wharton School, University of Pennsylvania, Philadelphia, PA; and Carol Cosenza and Mary Ellen Colten, Center for Survey Research, University of Massachusetts, Boston, MA.
authors.forename: Ezekiel J
authors.initials: EJ
authors.lastname: Emanuel
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000328:Adult; D000368:Aged; D003363:Cost Control; D017047:Cost Sharing / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000191:economics; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D010820:Physicians / Q000191:economics*; D011639:Public Opinion; D011795:Surveys and Questionnaires; D014481:United States