70% of medical costs are self-inflicted wounds: obesity, smoking, drug & alcohol abuse, lack of exercise. Figure out a way to motivate  people to reduce their own self-inflicted wounds and you will reduce medical costs. Remove incentives for people to eliminate these self-inflicted wounds (single-payer system) and you will see a continued increase in the behaviors that have created our medical cost crisis --> and eventually you will see cost explosion and/or severe rationing of medical care for all Americans.