Medicare is lurching toward disaster and the next administration will have to act to stop rising costs and get control of the $400 billion federal health insurance plan for the elderly, U.S. Health and Human Services Secretary Michael Leavitt said during a speech. Leavitt said paying for each medical action separately is wasteful and "it often results in bad referral decisions, sloppy hand-offs, duplications, fraud, and poor quality of care. The result is inappropriate care and unnecessary cost."