Very fine comments; a few brief responses:
I apologize for having misnamed Cutler's coauthor as Allison Brown rather than Allison Rosen. However, I don't apologize for having described her as an M.D. That was not denigration! It is entirely appropriate that an article on the economics of health care should be written by an interdisciplinary team consisting of an economist and two M.D.s.
One commenter asked me whether I would have spent $300,000 on end of life medical care for my father. The answer is yes. But now ask me whether I would have spent that amount if it would have required me to take on heavy debt or give up my judgeship and got into private practice. The answer is that my father would not have wanted me to make that large a sacrifice merely to keep him alive for a few more months of a rather miserable existence because of his cascade of ailments and deficiencies.
If I had been paying, however, I would have been vigilant to make sure I wasn't overpaying and I would have avoided painful repetitive tests. That is the difference between a system in which people pay for medical and a system in which the government pays.
I do not favor coupling a reduction in Medicare benefits with imposing a ceiling on what rich people can spend out of their own wealth on medical care. There are three points. Because Medicare will not pay for highly experimental procedures and does not pay 100 percent of a person's medical bills, there is no doubt that rich people get on average better medical care than poor people. There really is no feasible way of equalizing medical expenditures across persons regardless of wealth. But second, the purpose of accumulating wealth is to be able to spend it; if you forbid people to spend it in their preferred ways, you are destroying wealth. Third, when scarce resources are not rationed by wealth, it doesn't mean that they are allocated more "fairly." Under any feasible system of nonprice rationing of medical care, one can be sure that big shots, people with connections, physicians' relatives, the big donors to hospitals, etc., will get the best care.