Bruce,

Apart from that, Mayo has it right. They separate physician income from the costs they generate. They make physician income high enough that physicians can hold their heads high when they meet their lawyer and banker schoolfriends. Plus Mayo physicians are accorded special respect in society. It all adds up to a patient-focused system that attracts the very brightest physicians, a cycle that continuously improves itself.

Seems to me that one way to constrain costs is to value the parsimonious doctor. Physicians are trained that taking a patient history provides 80% of the diagnosis. Great respect is earned by physicians who can winkle out a diagnosis with their minds, hands and stethoscope. Does the system still allow time or opportunity for this win-win behavior? I'm not saying that physicians should practice without CT/MRI or whatever, I'm saying that physicians are more than capable of spending effectively, especially if the medical culture is pointed towards personal excellence. But introduce lawyers, income disparity and other distortions and physicians are driven to spend whatever is available.

I'd also observe that spending more time with patients improves the patient experience, increases compliance and leads to better patient satisfaction. That reduces cost as well, or at least makes patients happier to pay. The patient churn that typifies so much care today may be necessary to keep a practice's head above water but it's a lousy result for everybody in the end.