Economists frequently cite the “uncontrollable” rising costs of health care as the major culprit causing US budget deficits and looming apocalyptic financial disasters. Medical costs are projected to soon reach $3 trillion a year, approaching the same amount as the current federal budget, and with the health care component of the gross domestic product becoming 18%, this is most certainly a reality. These burgeoning costs are clearly the major issue and challenge for the long-term future of the health care system. Physicians must come to realize that in the near term, unless we change our ingrained practice habits, we will likely become active participants in the collapse of the entire US economy. Wall Street almost did it, using terrible judgment, hubris, dishonesty, and greed. We at the sharp end of care delivery are doing it legally and stealthily on a daily basis using our pens and keystrokes. We may blame malpractice lawyers, politicians, drug companies, and insurance companies for these cost issues, but we should admit that we through our actions are actually in charge of health care spending. Medicare and Medicaid are pushing state and federal budgets to breaking points. Health care costs are major disincentives to hiring and job growth, rendering US companies noncompetitive unless they move production out of the country. They are a drag on small employers who want to expand as well as a burden on entrepreneurs starting new businesses. Worst of all, these costs make health care unaffordable for many more US citizens, including the approximately 75 million who already have inadequate insurance coverage.