Physicians have a responsibility to patients - and to society, who shares the cost - to factor cost into treatment decisions. Medicine does not operate in a vacuum. Allocating dollars, in a family budget as in a state or federal budget, means making trade-offs. American medicine often ignores this reality. As a result, we spend more money per capita on healthcare than any other country but have little to show for it (see below). We've got to wise up. Physicians and other healthcare professionals - those who've chosen to care for society - should be leading this charge, not dragging their feet behind it. Some are, but too many are not. Misaligned financial incentives explain much of this problem. Check out what the HHS Center for Medicare and Medicaid Innovation (CMMI - emphasis on the "I") is doing to address these issues. Structural change is essential. So is culture change. Physicians hold considerable societal and economic power, so they have a responsibility to consider the broader implications of their clinical decisions.