From my perspective (a 30-year veteran physician executive), the syllogistic logic of these issues ought to be inescapable -- to help the patient, health care quality must be maintained if not improved (outcome measurement and monitoring is critical) and cost must be decreased at the same time through efficiency, discretion, and giving patients what they need (ie, better value for health care). 

Our health care system is particularly inefficient and, for some, inaccessible.  As for the quality of care, by any measure it is variable at best.  Why is it so hard to fix?  Why do we pale in relation to most of the industrialized world?

"Everyone's entitled to free care" does not mean everyone gets everything. Sometimes the incentives are poorly aligned.

The Commonwealth Fund contends that: "reforms physicians could champion to eliminate waste and avoidable complications, such as integrated systems of care, innovative payment models including shared savings, bundled payments, or global fees for primary, acute, or comprehensive care, and performance measures that promote care coordination." I say that docs aren't happy about any of that. I can hear them now....