Every government health program should operate under the same budget constraint that applies to other government programs. Failure to do so represents bad budgeting and economic, social, and health policy; redistributes income in perverse ways; and makes health care allocation extremely inefficient. No excuses for this failure to act—largely centered on fear of creating losers, distrust of all decisionmakers, and the search for permanent controls over an ever-evolving sector—hold water against this flood of adverse consequences.