Obtaining savings directly — by simply lowering payments or paying for fewer services — seems the most obvious
remedy . Programs designed to make cuts of this kind appear across the policy spectrum, from many, carefully sequenced
provisions of the Patient Protection and Affordable Care Act (ACA), favored by the Obama Administration, to draconian
proposed shifts of Medicare costs to beneficiaries and reductions in payments to physicians and hospitals, favored by several
Republican congressional proponents.