Unsung because Americans have a hard time pulling for public health and cannot see that too little care for someone else could also mean too little care at home. Neither doctors nor patients usually know the real costs of the medical encounter. Not for the lab tests, or the confirmatory consultation, or the late night phone call for four more Zocor for the patient who calls on his way to Missouri and forgot his meds. All have direct and indirect quantifiable costs. From a moral perspective, insulating doctors and patients from costs is crazy.
Fantasy land Separating people from prices distorts moral impulses in a predictable way.
Someone else pays. Maybe on a trip to Disneyland or in a dream. But definitely in a fantasy land. Who should pay and how they should be allowed to participate in decision making is the real tension in managed care. HCFA began prospective payment for hospital services, and thus the ethical issue of futility was born.