Since the time of Hippocrates, it has been assumed that a physician’s first obligation is to provide the best possible care to individual patients, without distortion by competing societal interests.1 This once near-sacrosanct principle is being tested by the high costs of the health care in the United States, which increasingly threaten the economy. Because physicians control much of the delivery of health care, they have a natural role in helping to control health care costs. But historically, our society has been uneasy about assigning this role to physicians. When people are sick and helpless, do they really want their physicians to be influenced by costs, or do they need to believe that their physicians want only to serve them according to their medical needs?
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