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Not convinced either way on that, but concede it might be for some items.
It has to be because there is no third party involvement. It makes sense, right?
So perhaps a true 'reform' might have been to enhance and improve the direct relationship between the doctor and the patient. if the patient is paying out of pocket then cost becomes a real factor. If third or fourth parties are paying then cost becomes less of a concern. and eventually no concern whatsoever.