>>As consumers, we have a duty to be on the lookout for MD's who shill for big pharma, prescribe needless tests, etc. but ultimately there is no substitute for an ethical, competent MD.
When we look at spiralling costs then, we have to look first at MD's.

A wise man once said "beware the poor doctor." So it's easy enough: return to the way it was in the good old days. Pay physicians so well that a) they have too much to lose to want to cheat, and b) there's not much of an incentive to cheat if you're already top of the food chain without cheating. Add the serious kudos that physicians used to enjoy and there's every incentive to be a responsible, ethical practitioner who has every reason to like her patients as well- even to do house calls and take on charity cases as the need arises. FWIW I once lived in a house where the previous physician owner had a room at the front and an external light so people could and did drop in day or night for care. That's what happens when money is not your object.

The problem in today's society is that parasitic types (e.g. currency traders) are lionized while heavily compensated healthcare managers earn bonuses if they can clamp down on nurse and physician incomes. Physicians in particular often have very large student loans and usually were smarter and did better at school than those who became parasites or who now want to clamp down on physician incomes to bolster their own. This is a breeding ground for resentment and/or indifference to rorting the system.