This communication reviews the increasing cost of medical care in the USA (13% of GNP in 1995) and the associated lack of access to care for 35 million citizens. Factors affecting cost and access are presented, including where the increases are seen. The resulting effects on the Federal government, private industry, the patient, and the physician are noted. The failure of a current mechanism of control of cost is illustrated as are the views of patients and physicians. The portion of radiation oncology devoted to palliative care is discussed for its potential to reduce costs by $150-$250 million through the elimination of excessive treatments and thereby contribute to the solution of excessive cost of care.