On that front, perhaps the problem arises from the patient-as-customer model. When you're paying that much for gold plated service, you WANT the system to serve you, pat you on the head, tell you you're doing a great job, and offer liposuction to sculpt those manboobs into shapely pecs.

Perhaps under a single payer system, the  docs would have the fortitude to tell Tubby to go lose some weight.