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As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Many of us are alarmed at the skyrocketing cost of medical care, including patients, who are the consumers. However, medical malpractice is not the reason for these increasing costs.

The fact of the matter is right now politicians and insurance companies are making decisions. We're saying we want doctors to be making decisions. And I think that will lead to a higher-quality, lower-cost system over time.

We see healthcare shifting from a procedure reimbursement, where in this country doctors are reimbursed for how many procedures they conduct, to a world where people will be reimbursed for the outcomes - did the patient actually get better, and what was the total cost of the cycle of care.

People spending more of their own money on routine health care would make the system more competitive and transparent and restore the confidence between the patients and the doctors without government rationing.

I think doctors are really suffering now. They're suffering in the sense that they feel torn between serving their patients in the best way they can and dealing with all of requirements of the insurance companies and the HMOs and the hassles and the paper work and the increasing pressures to do less and less for their patients.

Pay-for-procedure or fee-for-service reimbursement rewards doctors and hospitals for volume - not keeping patients healthy or being efficiency. Pay-for-Performance is clearly one tool that can change the incentives to reward quality.

The vast majority of doctors really do try to take the money out of their minds. But to provide the best possible care requires using resources in a way that keeps you viable but improves the quality of care.

Money has transformed every watchdog, every independent authority. Medical doctors are increasingly gulled by the lobbying of pharmaceutical salesmen.

We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.