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). 

Resource-based Relative Value Scale (RBRVS) was supposed to reduce some of the disparities in pay and encourage primary care; it has done the opposite--rewarding the more expensive care, particularly the procedures while short-changing the 'cognitive' services

It's schadenfreude: enjoyment obtained from the troubles of others.  That's where I find myself as I observe the surfeit of specialists juxtaposed to a dearth of primary care docs.