>>I don't know what IVR is, but many if not most of the labs in NY and NJ are owned by medical groups comprised of of the same physicians who prescribe the tests.

It's my error - I meant IVF.

>>His medical group owns the "more reliable" lab he wanted me to use.

This is called "self referral" and what you describe is illegal under Federal law unless the lab is in-office. Even then, numerous national and specialist physician groups are opposed to the practice of self-referral- apart from cardiology, which claims (with some merit) that there are good reasons to conduct some tests on-site.

Also note that laws are being introduced to prevent physician profit: e.g. 6001 of the dreaded ACA prevents expansion of or creation of new physician-owned facilities. This is to the advantage of existing facilities that enjoy far larger fees than the professional fee paid to the physician, so the last thing they want is to compete with the physicians. See if you can find a report by Merritt Hawkins showing that of the huge costs you complain about, the majority is captured by the facility/support services rather than the physician. In the case of Cardiology, facility and ancillary service fees generally would be triple those of the physician.

You also need to consider why physicians are gravitating to salaried positions if the pickings are so good. Just as a head's-up, extremely good US physicians are heading abroad and when I speak with then, 100% of the time they refer to the burgeoning administrative requirements and moochers siphoning from the system at every turn. When I practiced, there were few US physicians wanting to practice anywhere except the US. Tides be a-changin' and you need to look at the Texas experience leading up to its Proposition 12: make conditions too adverse for physicians and they vote with their feet.

>>Again, this is anecdotal and it might be isolated, but when I see our Medicare costs skyrocketing while that cardiologist drives off in an S Class Mercedes and I get into my Camry, I wonder.

My US lawyer drives a fancy Porsche. Start resenting professionals spending their $ the way they want, and people will start to quote Ayn Rand. ;-)

As for linking physician incomes to costs skyrocketing: only 21c of each dollar spent on healthcare in the US goes to clinical services, including physicians. IOW you could halve physician incomes and you'd make at best a 10% difference, not enough to explain why your expenditure is more than 100% higher than other nations' and rising.