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r e a c h i n g + c h a n g e s + n o + m a t t e r + w h a t + t h e + s u p r e m e + c o u r t + d e c i d e s + o n + p r e s i d e n t + b a r a c k + o b a m a % 2 7 s + h e a l t h + o v e r h a u l % 2 c + e m p l o y e r s % 2 c + l a w m a k e r s % 2 c + i n s u r e r s + a n d + m a n y + d o c t o r s + a r e + q u e s t i o n i n g + h o w + t h e + u n i t e d + s t a t e s + s p e n d s + f a r + m o r e + o n + m e d i c a l + c a r e + t h a n + a n y + o t h e r + e c o n o m i c a l l y + a d v a n c e d + c o u n t r y + a n d + s t i l l + p r o d u c e s + m e d i o c r e + r e s u l t s + o v e r a l l % 0 a u n t i l + n o w % 2 c + t h e + h e a l t h + c a r e + s y s t e m + h a s + r e w a r d e d + d o c t o r s + f o r + v o l u m e + n o w + t h e + f o c u s + i s + s h i f t i n g + t o + p a y i n g + f o r + r e s u l t s + a n d + c o o r d i n a t i o n + t h a t + e x p l a i n s + t h e + u r g e n c y + f o r + d o c t o r s + t h e m s e l v e s + t o + i d e n t i f y + a r e a s + o f + q u e s t i o n a b l e + s p e n d i n g % 0 a i t % 2 7 s + u n c l e a r + h o w + m u c h + m o n e y + w o u l d + b e + s a v e d + i f + d o c t o r s + f o l l o w e d + t h e + 4 5 + r e c o m m e n d a t i o n s + r i g o r o u s l y + p r o b a b l y + t e n s + o f + b i l l i o n s + o f + d o l l a r s % 2 c + a n d + m a y b e + h u n d r e d s + o f + b i l l i o n s + o v e r + t i m e + t h a t + w o u l d + h e l p % 2 c + b u t + c o m e + n o w h e r e + n e a r + s o l v i n g % 2 c + t h e + p r o b l e m + o f + h i g h + h e a l t h + c a r e + c o s t s % 0 a t h e + n a t i o n % 2 7 s + m e d i c a l + b i l l + h i t + % 2 4 2 6 + t r i l l i o n + i n + 2 0 1 0 + a + m a j o r + q u a n d a r y + f o r + c o s t - c u t t e r s + i s + t h a t + m o s t + o f + t h e + s p e n d i n g + i s + a t t r i b u t a b l e + t o + a + r e l a t i v e l y + s m a l l + s h a r e + o f + v e r y + s i c k + p e o p l e + j u s t + 5 + p e r c e n t + o f + p a t i e n t s + a c c o u n t e d + f o r + h a l f + t h e + t o t a l + c o s t s + a m o n g + p r i v a t e l y + i n s u r e d + p e o p l e % 2 c + a c c o r d i n g + t o + a + r e c e n t + s t u d y + f r o m + t h e + i m s + i n s t i t u t e + f o r + h e a l t h c a r e + i n f o r m a t i c s % 0 a d r + j a m e s + f a s u l e s + o f + t h e + a m e r i c a n + c o l l e g e + o f + c a r d i o l o g y + s a i d + t h e + g o a l + i s + t o + b e g i n + c h a n g i n g + a t t i t u d e s + a m o n g + p a t i e n t s + a n d + d o c t o r s % 0 a % 2 2 w e + k i n d + o f + h a v e + a + g e n e r a l + f e e l i n g + t h a t + i f + y o u + d o n % 2 7 t + g e t + a + t e s t % 2 c + y o u + h a v e n % 2 7 t + b e e n + c a r e d + f o r + w e l l % 2 c % 2 2 + s a i d + f a s u l e s + % 2 2 t h a t + h a s + p e r m e a t e d + a m e r i c a n + c u l t u r e + n o w % 2 2 + t h e + n e w + a d v i c e + i s n % 2 7 t + m e a n t + t o + o v e r r i d e + a + d o c t o r % 2 7 s + j u d g m e n t % 2 c + f a s u l e s + a d d e d % 2 c + b u t + t o + i n f o r m + a n d + s u p p o r t + d e c i s i o n s % 0 a t h e + r e c o m m e n d a t i o n s + w i l l + b e + c i r c u l a t e d + t o + c o n s u m e r s + a n d + d o c t o r s + b y + a + c o a l i t i o n + c a l l i n g + i t s e l f + c h o o s i n g + w i s e l y % 2 c + w h i c h + i n c l u d e s + e m p l o y e r + g r o u p s % 2 c + u n i o n s % 2 c + a a r p + a n d + c o n s u m e r + r e p o r t s + n e i t h e r + t h e + i n s u r a n c e + i n d u s t r y + n o r + t h e + f e d e r a l + g o v e r n m e n t + w a s + i n v o l v e d + i n + p r o c e s s % 0 a e a c h + o f + t h e + n i n e + m e d i c a l + s o c i e t i e s + s u b m i t t e d + f i v e + t e s t s + o r + t r e a t m e n t s + t h e y + v i e w e d + a s + o v e r u s e d + t h e i r + w o r k + w a s + c o o r d i n a t e d + b y + a + f o u n d a t i o n + t h a t % 2 7 s + a n + o f f s h o o t + o f + c a s s e l % 2 7 s + g r o u p + e i g h t + o t h e r + m e d i c a l + s o c i e t i e s + a r e + d e v e l o p i n g + a d d i t i o n a l + r e c o m m e n d a t i o n s % 2 c + c a s s e l + s a i d % 0 a t h e + m e d i c a l + s o c i e t i e s + d o n % 2 7 t + h a v e + a n y + p o w e r + o f + e n f o r c e m e n t % 2 c + a n d + f e a r + o f + m a l p r a c t i c e + l a w s u i t s + m a y + w e l l + p r o m p t + m a n y + d o c t o r s + t o + k e e p + o r d e r i n g + a s + m a n y + t e s t s + a s + e v e r % 0 a i n s u r e r s + w i l l + c e r t a i n l y + t a k e + a + c l o s e + l o o k + a t + t h e + r e c o m m e n d a t i o n s % 2 c + b u t + w h a t + t h e y + d o + m a y + b e + l i m i t e d + t h a t % 2 7 s + b e c a u s e + m o s t + o f + t h e + q u e s t i o n a b l e + t e s t s + a n d + t r e a t m e n t s + i n + t h e + l i s t s + d o n % 2 7 t + p a r t i c u l a r l y + s t a n d + o u t + i n + t h e + a v a l a n c h e + o f + b i l l s + p r o c e s s e d + d a i l y + b y + i n s u r a n c e + c o m p a n i e s % 0 a t a k e + a + r e c o m m e n d a t i o n + f o r + n o + a n n u a l + e k g s + f o r + l o w - 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