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One of the things driving medical costs so high is wasteful utilization. Another is double billing. The double billing piece is very insidious in that doctors are billing for two services when you go for one thing. A simple example is I went to a dermatologist for a plantar wart to be frozen. This is about 3 minutes in his office. He bills for an office visit and also for outpatient surgery. I paid a $25 co-pay for the office visit and a $50 co-pay for outpatient surgery. I argued it can’t be both at the same time but got nowhere with them, and my insurance company paid their share of both procedures. This is happening a lot these days. The wasteful utilization is even worse, especially with the elderly. For many old folks going to the doctor is their hobby. When my mother-in-law got bored she’d start thinking of things to make doctor’s appts. for, and Medicare pretty much picked up the tab for it all. Her regular doctors had her coming back for appts every 3 months with those appts not being much more than “How are you doing Mrs. L.” and then saying to come back and see me again in 3 months. When my father-in-law was in the nursing home one of his doctors would come by periodically, stick his head in the door, give a “How are you doing Mr. L.” and then move on to the next room, billing Medicare for as many office visits as he stuck his head in rooms. That my father-in-law had dementia and couldn’t really answer the question anyway didn’t matter. Another piece of the utilization issue is hospitals having bought up most of the private practices. This has resulted in doctors sending patients over to the hospital for every test they can even remotely justify, and ordering MRI’s when a simple xray would do.