That is the score in the game between economists and engineers who devise solutions to the health care crisis.  As NCPA’s President John Goodman explains here

I believe there are quite a few completely mutually exclusive views of health care. But today, I want to focus on two: the economic approach and the engineering approach.

The economic point of view. Economists see health
markets (along with other markets) as complex systems. The interaction
between 300 million patients, 800,000 doctors, almost 2.5
million registered nurses and thousands of other actors are so
complicated that no one person could ever hope to grasp the complete
picture. However, the science of economics is basically the science
that studies human incentives. As Adam Smith recognized more than 200
years ago, if the incentives are right, voluntary interactions usually
lead to good social outcomes, and perverse incentives usually lead to
bad outcomes. Smith also discovered that perverse incentives are more
often than not the result of unwise government policies……

The engineering point of view. Imagine a system of
pipes designed to carry water. To make the system work, you need to
sort the pipes, separating those that fit together from those that do
not. This system is also complicated, but it?s complicated in a
mechanical way. Suppose that after much study, we discover that Pipe A
always fits into Pipe B. It follows that all plumbers, everywhere in
the country, should always fit Pipe A into Pipe B. It really doesn?t
matter what the values and preferences of the consumers are. We already
know they need water. Nor does it matter what the plumbers think. If
they don?t insert A into B, no water will flow.

This is the way many people view the health care system ? including
many doctors, many hospital administrators, many insurance executives
and almost every health professional who works for the federal

If you see health care as primarily an engineering problem, you are
likely to view incentives are a nuisance and a distraction. We already
know what has to be done. A has to fit into B. Incentives are nothing
more than opportunities to derail the desired result. It isn?t that
medical engineers want incentives to be perverse. Rather, they don?t want incentives to be important. Certainly they shouldn?t be emphasized or enhanced.