Kevin,

What you describe is another example of what I call "overcare".  It needs to fall under greater scrutiny, and if a healthcare system for all is in place, which will do just that (yes, I am talking about some rationing in expenditures, where reasonable), I am all for it.  Where is the logic in spending thousands of dollars on life saving measures, for imminently terminal folks (albeit they need love, and I mean real love, in terms of care...I have a hard time believing cardiac resuscitation and placing somebody on a vent, is the type of compassion we want), when an indigent little kid may not get the meds he or she needs for an acute asthma attack, for example.   The waste in the American medical system currently is truly sinful.   We can still have superb care (better than anywhere else in the world), with literally HALF the money! (I'm not kidding).    Two essential requisites:

1. Practice BETTER, not MORE medicine.  That means judicious use of testing, procedures, and medication.

2. Serious revamping of the medicolegal climate.  The Tort reforms as they now stand (Thanks, Reg for the list), will probably not do the job, but are at least a step in the right direction.  Without this, you CANNOT accomplish goal #1...it's a vicious cycle.   Physicians, Nurses, PA's etc are and will continue to practice defensively.   Let me give you an example: (very typical scenario, let me assure you),

___________THE EXAMPLE

Mr. B (no..not Baerwald..heh,heh), assuming he has Health Insurance, makes an appointment for the Neurologist because of headache.  Firstly, he will need pre-approval from his primary care MD.  Say he gets it (no biggie, sometimes this can be done over the phone, so he may/may not need an actual appointment with his MD).  Probably, his primary care MD can handle the headache anyways, and Mr.B doesn't even need the subspecialist.  His primary care doc charges say, 75$ for a f/u visit.  BUT...his primary care doc participates in a CAPITATION plan (very common).  That means the doctor is payed so much for looking after the employees of Mr.B's company, and NO MORE.  Soo...the doc is encouraged to do less for those patients, not more.  In fact, the doc gets payed whether he sees those folks or not.  No incentive to look after Mr.B's headache, so Mr.B will definitely be heading to the Neurologist, and in fact, his primary Doc may even NOT want to see him and just "dump" the patient over there, after a phone call.

Now, the Neurologist's visit for a headache, since this is an initial consultation costs between 180 - 275$ (California would be at the 275 range, West Virginia at the 180 range).   The Neurologist doesn't get that money, by the way.  No,  he or she gets 50-75% of that maybe 6 months down the road from the visit, after  the claim has been rejected once or twice, by a High School grad who knows nothing about the patient's situation or illness, just because the diagnosis code is not "appropriate" for the visit, or simply "because" (there is a routine practice in many insurance companies for claims to need to sit on the desk of a processing agent for 20-30 days minimum, before they are even LOOKED at). 

OK, now we have the board-certified Neurologist, who, after talking to Mr.B and examining him, is quite confident based upon his/her 14 years of training, that this is a common migraine or muscle contraction headache (take your pick).   Both conditions do NOT require ANY testing.   What IS required, is an compassionate and reassuring approach from the physician, to allay the patient's fears, and establish trust that a treatment trial will be attempted, and that various combinations of meds or other treatment modalities will be used to help improve Mr.B's life quality.  Hopefully headache free, but maybe not; still...improved QUALITY of life is the goal.  The patient is told that testing like scans etc...is not necessary now, based upon the symptoms, but that the issue can be readdressed if clinically appropriate at a followup visit. 

OK...still with me?  Total cost of appt and medication, say we take the low end : 180 + 35 (the 35 being for a good migraine med, nongeneric.  For generic say 5-10).  Let's talk round numbers...Mr.B's incurred expense (remember he's not "paying" for it, correct?   The "system" is), is around 200$ for this.  

Another scenario (this is more likely than the "conservative" approach above).  The Neurologist is still quite sure this headache is not serious, but he's had a lawsuit before for a missed brain tumor, so even though EVERY thing he has ever learned about headache makes him conclude this is migraine, given the litiginous climate, he orders a CAT scan on Mr.B.   Because of the realistic concern of "not missing a brain tumor", the scan is ordered with and without intravenous contrast agent.   That's, uh...2 scans..right?   Mr.B has to take the afternoon off work for the scan, but he had to for his intial Neurology appt, so that's not a problem. ...(or is it?...ask his employer).  The cost of the scans is around 1200$; the contrast agent costs 300$, and the IV bag, pole and accessories that the hospital charges to run in the contrast agent, is a bargain at 75$.   Now we're up to a cool and comfortable 1575$, but wait...we're not done yet!   The Radiologist at the hospital needs to read and interpret the scan.  Total time for this, around 3-5 minutes (at most); ok, I'll give 5 minutes including the dictation of the report.   Cost? At least 150$; could run as high as 325$.   Let's go on the low side.  Now we're up to 1725$ (but it's OK, 'cause Mr.B is not out of pocket on this, it's play money, just a number, that's all).   The scan, shockingly turns out to be absolutely normal (yes, Mr.B does have a Brain afterall, and it looks just like in the anatomy books...surprise, surprise).   In fact, most of the head scans done all day by that hospital Radiology department are entirely normal (over 80%).   They found one brain tumor in a guy who lost his vision and got paralysis, and metastases in another patient with known Breast Cancer (hmmm...another surprise).   

Even more of a suprise, Mr.B's headaches seemed to magically disappear after his asshole supervisor at work was run over by a Mack Truck, right in front of the plant,   OR the 20$ worth of medication that Dr.X prescribed really took the edge off the headaches (pick either scenario...I like the first one better).

Math lesson: 1725-200 = 1525 (or should I say, "you do the math").

Math lesson #2.  Dr.X ordered an MRI, not a CAT scan (this is becoming a more common practice). Total cost of MRI 2000 to 2500.   Radiologist Interpretation for that one (it takes about 30 secs to one minute longer to read), definitely 350-375 (and that's pretty consistent nationwide).   Total= 2350 to 2875$, hard earned yankee dollars...for a headache.  

But...this is all just fluff.  Remember, it's just imaginary money we're talking about.  Mr.B feels good about it.  His doctor did "everything" for him, he got great care, and best of all he only had to pay a 15$ co-pay to the doctor.   The "rest", the Insurance Company looks after.  

Get the picture, Kevin?   This scenario multiplied ad absurdum is the reason the healthcare costs in this country are so astronomical, and we have a healthcare "crisis".   We created the crisis.  We have the fix already staring us in the face.

Have a great, and hopefully, healthy day,

Gene