As the U.S. seeks to drive down medical spending, one goal is to eliminate tests and treatments that are ineffective while encouraging price competition among things that work. Passing the buck on to the consumer isn't enough; on The Pump Handle, Liz Borkowski reports that giving patients an incentive to save money on health care causes them to see the doctor less, not "shop smarter." Meanwhile, Orac provides an update on "Choosing Wisely," a program meant to weed out useless procedures by appealing to the prudence of medical specialists instead of patients. In the three years that it has been in effect, the initiative has had little measurable impact. As Orac writes, "As much as physicians want to do the right thing for their patients, changing behavior in large numbers of people is among the most difficult human endeavors of all."