>>Exactly what I meant when arguing against another system divorcing patients from cost and motivation to think about neccessary steps

It's true that you don't need to be a carpenter to know whether a table is well made, but healthcare is highly involved and even assistance from "Dr Google" may not equip lay people to make decisions about appropriate care. Especially since when dowager Aunt Martha is admitted it's natural for family members to make up for prior inattention by fiercely demanding the very best for this wonderful human being.

The best person to spend precious healthcare dollars wisely, is the benevolent physician. The physician has to be positioned as patient advocate who may not be overridden by insurance clerks or politicians whose role should be limited to negotiating better deals for bulk pharmaceuticals and other equipment needed by caregivers, sponsoring research into the most cost effective drugs and materials, and controlling spending at both ends of the bell curve. In all my experience, physicians value robust, considered advice on best practice that reduces uncertainty and allows the physician more time with patients.

Meanwhile Joe Public needs to reconcile himself to the idea that a lung transplant for Aunt Altzheimer is not a proxy declaration of love and respect, it is an immoral diversion of resources that might deliver Aunt Osteoarthritis a new hip so she can walk her dog again rather than getting pneumonia.