As the cost of care increases and insurers pass on those costs to patients, patients begin to use fewer services, particularly elective procedures. They delay hip and knee replacements—and that’s bad news for hospital budgets. Some experts believe in making patients responsible for cost containment by forcing them to use the system less. But when they do that, as we see in Colorado and other places, some hospitals suffer, particularly the ones that serve poor people in inner city neighborhoods. We hope that the Gazette will stay with the story, and that other papers will explore this topic and look at how reform will change the financial picture for these hospitals, if at all.