In the discussion of cutting health care costs, it’s often pointed out that the doctor’s pen is the most expensive piece of technology.

Hospitalist Bob Wachter talks about the medical profession’s zeal to “do everything” as a major driver of health spending. So, how can we stem this tide?

Doctors are programmed to advocate passionately for the patient in front of them, with little regard for the macroeconomic impact of their decisions. Dr. Wachter argues that by involving more of them in larger integrated health systems, physicians are part of a more communal setting. That’s important, since, “it involves creating structures that make the docs confident that any money they save stays in their immediate organizational circle, reallocated by reasonable people to other patients who might benefit more.”

But, as it stands, most doctors practice in solo, or small group, settings, making it “more likely the docs will fight such reallocation and tar the effort as ‘heartless rationing’ by ‘faceless bureaucrats’.”

I’ve argued that transitioning the majority of the American health delivery system into integrated models is one the biggest challenges before us. But, as Dr. Wachter reminds us, it’s not as easy as waving a wand and magically propagating the Mayo model nationwide. Indeed, these established systems have been around for 50 years or more.

If we can somehow find a way to successfully do so, it will immeasurably help.