Collective bargaining isn't going to do much as negotiation is always about moving the costs around, it doesn't truly reduce them. We need to be looking for ways to actually make things more efficient.

I have recently been having some dealings with a medical office that provides a clear illustration of the problem. Doc orders test A and unrelated test B. Scheduling requires me to make follow-up appointments for each test because the insurance "wont pay for" discussing two of them in one visit. Why do we have a system where the incentives are so messed up?? Note that I think this is a case of saying the quiet part out loud, not that they are unusual. One thing per visit is the norm when dealing with insurance.

It wouldn't have to be that way. Make most such follow-up visits folded into whatever they are a follow-up on (even if whatever it was was external), the visit itself isn't billable and so the doctor is free to structure things in the most efficient way--and we generally don't need "you're ok" followup visits. You can't go with a full result-based system because that will cause cherry-picking (look at what we have seen with Medicare advantage plans), but there's low hanging fruit out there.