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Theres no barrier. A physician can do this but theres increasing work to make it happen. The natural path of least resistance is to prescribe the preferred drug. These are levers. This is what is been called enlightened paternalism or the structure of incentives make it such that do what the insurers would like to maximize, the rational course of achieving cost savings forever is the equivalent drug is the outcome. As a physician, however, and as a patient one needs needs to remember thethat can be at times and opposition between reason and rationality. One thinks of the movie dr. Strangelove, for example, where dr. Strangelove who at the end of the movie as you know led by peter sellers, as eloquently rational madman who is leading the world of destruction, arrived by set of incredibly rational steps through economic game theory. So this idea that one can create a rational system which at times can produce unreasonable results i think is a dilemma that exist at the heart of modern med

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