No component , man-made or biological, can physically maintain a growth rate in the 10-15% range before completely overwhelming the system in which it lives. The medical system is no exception, and at it's current growth rate will consume our whole GDP in a short few years. Yet what group in the U.S. is in favor of reduced medical spending? Not drug companies that continually charge higher & higher prices for drugs that in many cases are no better than generics. Not hospitals, who are always complaining about loosing money while at the same time adding yet another new wing. Not physicians, who are paid ridiculous amounts of money for performing more & more procedures, 30-50% of which are known to be unnecessary. Not insurance companies, who (much like Las Vegas) make money by skimming a percentage of the total "pot"- bigger expenses = bigger premiums= bigger profits. Not the consumer, who generally pays little if any of the bill anyway and equates more care with better care.

It seems that there is no one who is at all interested in lowering costs at all. Indeed, the government instead proposes to spend a trillion or so more to "reduce costs". Two proposals come to mind that might create a group that has an interest in reducing costs:

A. Create a cadre of physicians paid a salary plus a bonus based on providing good outcomes at a cost less than the prevailing rate spent on that particular disease. The existing procedure rate would drop at least 30% immediately, along with the associated costs.

B. Structure medical insurance with, say, a $2,000 deductible of which the unused portion is refunded to the consumer every year. If you spend $700 on medical care then you would get a $1,300 refund that year. Now, the patient may ask "Is this really necessary?' or "What are my other options?" At present, these questions are rarely asked or even considered.

These two would definately result in some major group interested in reducing costs. Other ideas may be just as or more effective. However there is absolutely no discussion of any substantive ways to reduce costs. Anyone with some other good ideas?
Steve S