This is hardly surprising, and it's unfair to try to turn it into a problem with "entitlement programs". There are many examples of this kind of thing -- and private insurers aren't pushing back on the costs, either.<p>Take the anti-viral drugs acyclovir and valacyclovir. They're both anti-virals used to treat diseases caused by the herpes simplex virus (e.g. shingles, chicken pox, cold sores, herpes, etc.), and are both commonly prescribed to patients of all ages. The only difference between them is that valacyclovir is a pro-drug -- it metabolizes to acyclovir -- and has slightly higher bioavailability, which means that patients can take three doses a day, instead of five. Otherwise, they're equivalently effective medications.<p>Granted, three doses a day is easier on patients than five doses a day, but that convenience comes at a cost: valacyclovir costs about five times as much as acyclovir. Your doctor won't tell you this -- she'll just prescribe the valacyclovir, in nearly all cases -- and your private insurance company won't do anything to encourage you to take one drug over the other. About the only way you'd know is if you tried to buy the drug without insurance, and your pharmacist told you that you could use this <i>other, cheaper</i> medication to save a lot of money.<p>Not only are "entitlement programs" not the problem here, they could actually be the solution: a single-payer health system would have an economic incentive to push back on providers, and encourage them to use more cost-effective drugs. Our current, private insurance system is almost totally blind to cost effectiveness, because nobody in the chain has any incentive to care. The final costs of the system get passed back to employers in the form of annual rate increases, when it's too late to do anything about them.