I've mentioned before that I think one primary way to reduce healthcare costs is to allow nurses to do more. There are a number of basic procedures which don't require full doctors.
I read "Complications" by Atul Gawande last week, and it sparked another idea. Dr. Gawande mentions specialization and repetition as major factors in producing good outcomes. In particular, he mentions hernia surgery. The average hernia surgery takes 90 minutes and has a complication and reoccurrence rate of 5%. Very few places deviate significantly from this number, except for one strong outlier.
There's a hospital outside Toronto that does exclusively hernia surgery. Every doctor in the clinic does hernias, all day and every day. As a result, because of the constant practice, hernia surgeries take 30 minutes and has a complication/reoccurrence rate of 1-2%. These surgeons never even underwent full medical training - they just learned enough to deal with hernias and complications accompanying hernia surgery.
Similarly, if some percentage of our nurses and doctors focused solely on particular common issues (gallstones, bypass, etc) and worked exclusively on that, they'd require less training (and consequently less pay) and procedures would be faster and more effective. The remaining doctors can still undergo the same extensive training and deal with a greater variety of rarer things. In other words, we could a) specialize our nurses more and b) create an intermediate between doctors and nurses that can do medicine like a doctor in particular instances, but not all instances.
This could be a powerful driver to reduce healthcare costs.