what we started to have was studies done by jack wennburg at dartmouth and others, which showed large variations in medical practice, that you were much more likely to have a cataract surgery in onet of the country than another, or in one just small town compared to another small town. we couldn't understand the variation. it wasn't due to differences in ages or genders or even health status. nothing seemed to be correlating with it other than medical pctice factor, how the doctor decided torovide care. no at e beginning, in the '80s, it was very easy to contain costs with managed care and without anybody complaining because there was so much wasteful activity going on-- too many x-rays, too many laboratory tests, all sorts of things-- so that a thoughtful physician, working with a managed care organization could slow the rate of rising costs by getting rid of this unnecessary care... and this was very appealing. gee, we've got a magic answer. there's a loof services that really have marginal value. and so you'd hope that managed care could identify those and really weed out those ser