For more than 30 years, physicians have heard concerns about escalating health care costs, including warnings of dire consequences from unsustainable trends. Alarms first sounded in 1980 when health care costs rose to 9.2% of the gross domestic product from 5.2% in 19601 and became louder when they jumped to 12.5% in 1990. (These numbers appear almost quaint next to the 2010 figure of 17.2%.1) Physicians were criticized because they had the “power of the pen” and were assumed to be the prime movers in all health care spending, and they began to face the ethical conundrum of their dual roles as patient advocates and stewards of health care costs.