"Evidence shows that making health care more expensive does induce people to consume less of it. But the same evidence shows that people do not cut back only on care that is ineffective or somehow luxurious; instead, they cut back across the board. Expecting sick Americans to decide on the fly in an opaque and uncompetitive marketplace what health care is cost-effective-and what is not-is an unrealistic and unfair approach to containing costs.... The excise tax is a shotgun blast. But what's needed for cost containment is a scalpel."