Unfunded mandates for "on the ground" day to day operations from organizations such as CMS and JC that, at the end of the day create huge waste of resources, top heavy hospital administrations that must justify their existence daily through expensive campaigns meant to increase efficiency and disconnect between physician administrators and those in the clinical area are not insignificant drivers of "out of control" health care spending. Hospital oligarchy has become absurd in the last 15 years.
How are the oligarchs going to do their jobs with less money? It's almost as if they believe that their salaries are completely unrelated to revenue generated from taking care of sick people.