the reason why the "too much health care" meme is out is to distract attention from insurance companies and their practices and profits. Its an effort to blame doctors and patients for high health care costs.

And while there is an argument that Medicare could achieve some savings through implementation of "comparative effectiveness" studies, private insurance companies already incorporate that data -- its what "managed care" is all about (HMO and other 'primary care physician' based plans.) The "efficient" model isn't efficient because it has better data, its more efficient because its more 'socialized' (doctors -- indeed, all service providers-- are salaried, and not paid on a fee for service basis, just like doctors are salaried in Britain's National Health Service.) The systems have very limited choices -- and continuity of care is impossible if you leave the system (i.e. if you switch insururs to/from Kaiser Permanente, you have to switch all your doctors.)

In other words, the only way to achieve substantial savings in the health care system is a complete reorganization of that system. ("single payer" isn't enough because "fee for service" even under single payer is remarkably inefficient.) the insurance companies don't want that to happen, because it would drive them out of business (in favor of 'hospital corporations")

Is it similar to those "Gold Plated" and "Cadillac" plans? Also undefined?

Atul Gawande in The New Yorker piece which has gotten so much attention seems to view it as a fault of the medical profession. The doctors, clinics, and hospitals are searching for ways to make their businesses profitable, and thus offer and even order more tests than (seemingly) necessary.

In general, I feel the GPs are being shortchanged in the way healthcare dollars are distributed, and they do deserve to make a decent, predictable income. The loans for medical schooling are staggering, the costs of personnel to manage all crazy quilt of insurance offerings are onerous. But....

My own GP who gets a set rate for each patient in the HMO no matter how demanding the case is; but I think the co-pays go directly to the practice. I'm continually being told that a prescription I've taken for over 40 years now, for a chronic condition which has not changed over the years, cannot be renewed unless I come in for "a visit." Caching. Is the HMO shortchanging of GPs part of the problem?

My understanding is that the set rate is not very high, as the Big Insurer Beginning with the First Letter of the Alphabet must make its "numbers," so patient care is considered a "loss."

If a patient goes to a higher copay for a lower insurance premium, does the GP gatekeeper get a lower rate from the Big Insurer? I know that my doctor was stunned when I told him my monthly rate; he said he doesn't see very much of that.

Are doctors in HMO's still contractually required to not talk about how they are reimbursed?

Point being--if doctors are unfairly reimbursed, they'll begin doing whatever to bring in more revenue. And the Big Insurers do take up to 30% of the healthcare dollars paid to them. How can the system work for everyone?

Single payer.

I think that the reason this talking point is out there now is because one big way they are planning to cut costs is by denial of care. So, the meme is that people are overusing health care.

Of course, in most cases people are getting less care, not more. More and more surgeries are done on an outpatient basis. (Regarding the comment above, I too have run into being required to pay for an office visit to renew a lifelong prescription. I stopped the prescription. The cost of an office visit at my clinic has apparently doubled. Doctors and hospitals are underpaid in many (more serious) cases, so they have to find ways to make up for it with other cases.)

Cost Containment was started in the ’80s in health insurance plans. Procedures were to be reviewed to see if they were necessary. You could appeal if denied. This was demonstrated not to be cost effective by statistical studies. Since most procedures recommended by a doctor are necessary, it costs more to review each of them than to occasionally pay for an unnecessary one. Besides, it was decided by the insurance company, not the doctor. So the meme that the government will be deciding is also a non-starter. It is already being decided by someone other than your doctor. It is about denying care to cut expenses.

They will try to deny care to older people because most medical costs are incurred when people get old. Some people will be considered ‘useless eaters’, useless consumers of health care. So, do we get an allotment for life? We won’t get the care we need, just the amount we are allowed? So, if I stay healthy, but someone runs me over, I may ‘overuse’ the health care system. Or, if I never require expensive treatment, why wouldn’t my allotment be applied to someone else? Well, that is what insurance is. Are we talking about providing health care, or providing insurance? Not the same thing.

My elderly parents rarely needed any medical care until their 80s, and even then very little, but they paid for insurance their whole lives.

There are many holes in the system, but overuse is not really one of them.