"If we solve our health care spending, practically all of our fiscal problems go away," said Victor Fuchs, emeritus professor of economics and health research and policy at Stanford University. And if we don't? Dr. Fuchs, who has been called the dean of American healthcare economists, has spent five decades studying the healthcare problem. In his view, what is needed is the sort of major change that comes once in a decade, perhaps, or even just once in a generation. But change, he believes, will not bubble up from within the healthcare system itself. Here is a recent conversation with Dr. Fuchs about the nation's healthcare costs.