If people are unaware of the costs of care and just want what they want, when they want it; and when those costs are unrelated to the possible benefit of that care or what evidence-base medicine has said works or does not, it will be unlikely that care will end up being judged as efficient or cost-effective.  Compounding this is the everyday observation that practitioner "A" is virtually unaware of what practitioner "B"had recently done for that same patient.  

Simply put, it is oftentimes hard to justify the cost of care that is being passed along to consumers.  Moreover, spending less money on care does not necessarily mean there will be any reduction in quality.  In an Institute of Medicine report referenced below we learn that: "Health care in America presents a fundamental paradox. The past 50 years have seen an explosion in biomedical knowledge; dramatic innovation in therapies and surgical procedures; and management of conditions that previously were fatal ... Yet, American health care is falling short on basic dimensions of quality, outcomes, costs and equity."

"Bad Communication costs us *750 billion for health care." The Affordable Care Act takes this into account, reminding us that an informed consumer may make better choices.  Indeed, the ACA "encourages greater use of information sharing technology, better coordination of information and care across the health-care industry and removal of the mystery about the price of medical care."

About 30% of health care spending (2009; $750 billion) was "wasted on unnecessary or poorly delivered services and other needless costs. Lack of coordination at every point in the health care system is a big culprit."