Doctors are relatively uninformed about health care systems, outcomes research or health care economics, specifically the costs of care and cost-benefit.  Is that a critical knowledge gap?

Managed care (or a reasonable facsimile) is "still with us….its role is certain to grow" and its "appeal is financial."

Just today in pediatrics, Aetna refused to pay for a visit of a child with a probable goiter and strong family history who needed diagnostic lab tests—they do not accept rule-outs.  Last week Oxford levied a $50 deductible and $25 co-pay for the most efficacious eardrop we have in our armamentarium; Reason? This drop, containing an antibiotic and a steroid was not available generically; they were forcing me to use a plain eardrop – not what the doctor ordered!

Mental Health Parity; Let the HMO's Be Damned!

To improve the insurance coverage of mental health care, employers and group health plans are ruled against discrimination, * i.e., providing less coverage for mental health conditions than physical ones. 

Note: this rule was originally approved in 2008 and it will finally become law in July 2010.  "The administration said the new requirements could increase premiums by four-tenths of 1 percent, or $25.6 billion over 10 years. Businesses with 50 or fewer employees are exempt."