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No great optimism is justified either when it comes to cutting medical costs overall. Medicine cannot be made cheap, given the costs of its technology, and by its nature it cannot be anything but a seller's market. But U.S. health care bills do not have to shoot up as rapidly as they are doing now. The big question is whether doctors, hospital administrators, insurers and employers can devise ways to bring the public the benefits of technology at an affordable price, without a federal whip being held over them.