If a person needs hospitalization a negotiation session develops between the physician and the managed care person for days or outpatient vs inpatient. It is not based on the needs of the patient but the negotiation skills of the two 'combatants'. The government can determine how to fix medicine, there appears to be no one in government who understands the process. Specialists are responsible for the cost of medicine. With or without them the cost goes up, likely higher without them.
Reality speaks for itself.
Most disease can be fixed by health life changes. Disease happens one way or the other. It builds a whole entity of its own which is very costly, very meddling, and saves no money. As managed care is viewed from actual practice, we can see that some of it clearly increases costs and decreases quality or both. The concept of the 'gatekeeper', be it a nurse or physician, gets in the way of getting appropriate care to people on a timely basis.