Today I read an article about how the high cost of our healthcare relative to other countries primarily results from the higher cost of pharmaceuticals, insurance companies and administrations. Certainly I feel validated in my long-standing beliefs. But the complexities of our system, considering the expectations and entitlements coupled with liability fears, make solutions seemingly impossible. Earlier this week, one patient who was prominent in the community, expected special treatment because of his social status. Another patient who is totally noncompliant with medical advice expected special treatment because of his sense of entitlement. Adding to the problem, the medical system has prioritized patient satisfaction over quality and allows patients to make poor decisions with little resistance from the physician because of the fear of low patient satisfaction survey scores, which adversely affect reimbursement. Many of us physicians with great ideas are squelched because we represent good patient care over this bureaucracy; and, in case there is any question, WE are not in charge anymore.