This article by Atul Gawande highlights both the incentives built into the system for driving up health care costs and elements of what our system will have to look like to keep costs under control without sacrificing health outcomes. He draws in part on an intriguing comparison between a high medical cost area, McAllen, Texas, and a low cost but otherwise relatively similar area, El Paso, Texas.
One interesting aspect of Gawande's analysis is that the incentive problems he describes exist today regardless of whether we have private or public payors and the organizations/regions that have kept health costs low have formed despite the incentives. [Changes in what gets paid for could substantially change these incentives]. We as a society will need to figure out how to create the conditions in which professional norms seem to outweigh economic incentives.
But, this is a thought-provoking article.