Today's New York Times has an essay by cardiologist Sandeep Jauhar, MD that depicts and decries the excessive consultation and testing -- especially medical imaging -- that he believes is the prime driver of the United States' spiraling healthcare costs. While he seems to believe some of the blame lies with greedy doctors, patients who confuse quality of care with quantity of care, and overuse of new technology, he says the main culprit is the "perverse financial incentives of our current [healthcare] system." CMS adapted to rising healthcare costs by cutting reimbursement rates. Since doctors get paid what they bill, many have responded by increasing the quantity of services. If you get paid by the task, and you're going to get paid less for each task you perform, and you want your level of income to remain the same, you're going to perform more tasks, whether they are needed or not. While on the surface this may appear to be an anti-technology argument, it really isn't. If the dynamic that Jauhar depicts is accurate, it would still occur regardless of the rate of introduction of new technology. If anything, reliance on older technology could give rise to MORE unneeded procedures, since doctors would presumably be paid less per test than if they used the latest technology. That gives credence to the argument of AdvaMed and others that the main culprit isn't the high costs of new technology, but a broken system of compensation and financing. Certainly, part of the problem is that patients sometimes demand access to new technology when they don't need it, and doctors are all too willing to oblige them. But it's not the whole problem, or even a substantial part of it.