Laupacis, Anderson and O'Brien propose amending regulations to get better information so that effective drugs can be made available without bankrupting the healthcare system. We reckon that this proposal is rather like shutting the barn door after the horse has bolted. If you want to avoid bankruptcy, first you have to know what you can afford to spend. From our observations as a public agency responsible for setting drug subsidies in New Zealand, operating within a budget constraint may better help to achieve many of the desired outcomes.