I recently took care of a 50-year-old man who had been admitted to the hospital, short of breath. During his month-long stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist. He underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to work-up chronic anemia). Despite this wearying schedule, he maintained an upbeat manner, walking the corridors daily with assistance to chat with nurses and physician assistants. When he was discharged, follow-up visits were scheduled for him with seven specialists. This man's case, in which expert consultations sprouted with little rhyme, reason or coordination, reinforced a lesson I have learned many times since entering practice, in our health care system, where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur. Though accurate data is lacking, the overuse of services in health care probably cost hundreds of billions of dollars last year, out of the more than $2 trillion that Americans spent on health. Are we getting our money's worth? Not according to the usual measures of public health. The United States ranks 45th in life expectancy, behind Bosnia and Jordan; near last, compared with other developed countries, in infant mortality; and in last place, according to the Commonwealth Fund, a healthcare research group, among major industrialized countries in healthcare quality, access and efficiency. And in the United States, regions that spend the most on healthcare appear to have higher mortality rates than regions that spend the least, perhaps because of increased hospitalization rates that result in more life-threatening errors and infections. It has been estimated that if the entire country spent the same as the lowest spending regions, the Medicare program alone could save about $40 billion a year. Overutilization is driven by many factors—' defensive' medicine by doctors trying to avoid lawsuits; patients' demands; a pervading belief among doctors and patients that newer, more expensive technology is better. The most important factor, however, may be the perverse financial incentives of our current system. Overconsultation and overtesting have now become facts of the medical profession. The culture in practice is to grab patients and generate volume. 'Medicine has become like everything else,' a doctor told me recently. 'Everything moves because of money. ' Consider medical imaging. According to a federal commission, from 1999 to 2004 the growth in the volume of imaging services per Medicare patient far outstripped the growth of all other physician services. In 2004, the cost of imaging services was close to $100 billion, or an average of roughly $350 per person in the United States. Not long ago, I visited a friend—a cardiologist in his late 30s—at his office on Long Island to ask him about imaging in private practices. 'When I started in practice, I wanted to do the right thing,' he told me matter-of-factly. 'A young woman would come in with palpitations. I'd tell her she was fine. But then I realized that she'd just go down the street to another physician and she'd order all the tests anyway: echocardiogram, stress test, Holter monitor—stuff she didn't really need. Then she'd go around and tell her friends what a great doctor—a thorough doctor—the other cardiologist was. 'I tried to practice ethical medicine, but it didn't help. It didn't pay, b