The Texas Medical Center conducted a survey of 9000 consumers and 450 physicians in 15 large population states, asking them questions about health care spending. (TMC Survey) 91% of consumers said that having health insurance was very important to them. About 65% of respondents said they pay more than 5% of their income out-of-pocket for health care related products and services and 49% indicated that they cut other spending in order to pay for health care. Among uninsured respondents, 2% of income was an indication of the most they could afford to pay for health insurance or health care, and 55% of the uninsured said expense was the main reason they didn’t have insurance. (I just want to briefly interject that a lot of these uninsured individuals are finding money for unhealthy things, like cigarettes, fast or unhealthy food, alcohol, etc.) Why are costs high and rising? 47% of physicians and 28% of consumers blame insurance companies, 30% of consumers and 19% of doctors blame drug and medical device companies and 23% of consumers and 12% of physicians blame the federal government, while only 10% of consumers and 9% of doctors lay fault on hospitals and almost no one ascribes it to doctors. Hard to fix the problem when you are so wrong about the causes. Providers, and the product companies, are the very predominant cause of increased spending. And doctors are especially at fault, since they are the ones ordering almost every service. How do we solve this mess? The respondents, correctly in my view, say we should raise costs for people who engage in unhealthy habits, 40% of doctors and 28% of consumers (of course, the consumer respondents must not think any of them fit in this category); make cheaper catastrophic coverage only insurance available, 23% of physicians and consumers; and encourage doctors to follow practice guidelines, about 20% of overall respondents (just want to note that if you think this is a solution, you should have acknowledged that doctors may be responsible for higher spending). According to the physician respondents, only a third are paid on a salary basis and most have some compensation method that rewards volume. About 70% of doctors think that the ideal system is either all salary or just very small incentives. Cognitive dissonance at work again, since only 2% of the physicians thought they had any responsibility for higher spending. While the survey confirms the pain high spending is causing, lack of knowledge about its sources and potential remedies is obviously an impediment to fixing the problem.