>>Yes, the patient is accountable - but at what cost?
>>Since there is no apparent cost to the patient, there is no restraint.

That's the theory- but in real life, Kevin is right. IMHO physicians face a perfect storm of second-guessing insurance clerks, ambulance-chasers and patients who are delighted not to have to claim on home insurance but frequently consider health insurance to be a retainer against which you need to consume or you got a bad deal. "I'm paying big bucks and want to see some value, so don't fob me off with listening to my chest! Leave no stone unturned."

Also consider that when you are the one with the disease, incidence for you is 100% with no comfort at all from being told it's 1-in-a-million across the population which is why the expensive test that might have allowed detection in time, doesn't get ticked for everybody every year.

I'm not saying that doctors don't over-service when revenue is connected- of course doctors are human beings with self-interest- but you have to consider the rapidly changing face of US healthcare as physicians migrate to employee status with zero, nada connection between income and service level. If greed were the US physician motive you assert, the trend would be the reverse. Instead the consistent rationale for the change is to move away from the admin and money side and just practice medicine.

Seems to me the best person to be put in charge of the $ is the person who wants it least- which used to be and in many countries still is the physician. If you're worrying about over-servicing to bump revenue, revert to the old days when doctors earned heaps and were aristocrats and 1%ers in any community. IOW they had lots to lose and no incentive to over-service to keep up with the Smith and Jones who were plodders at school but did law and banking. Ironically the greedies are smart enough not to choose medicine any more, so maybe we should expect to see more doctors who want to practice medicine rather than buying a new boat.