The biggest companies have hundreds of thousand employees and are paying billions of dollars a year on health care. Rather than having these companies leave the United States to reduce their tax burden to be able to pay employee healthcare costs (through corporate restructuring), or go bankrupt (like General Motors), this book provides a far more attractive option. Lead the charge; buck the system. If they promote democratized medicine for all their employees, it would strip down the costs of care for office visits, hospitalizations, lab tests, imaging, and other diagnostic procedures. Why should these companies pay for an elaborate ultrasound study, with charges averaging $800-$1,000, when, in most cases the necessary imaging can be done part of the mobile-technology driven physical exam, and essentially for free? Why are patients kept in the hospital or even admitted, at the $4,500 per day average fee, when they could have remote monitoring? Why pay for sleep studies in a hospital laboratory that cost at least $3,500 when they could be performed for free, at least a screening exam, in the patient’s home? Why haven’t such employers enforced all of the hundreds of the Choosing Wisely modest but clear-cut recommendations of unnecessary tests and procedures? These are but some of the ways large employers can exercise their massive muscle to reduce costs and catalyze bottoms up medicine. They also can have marked influence over the big health insurance companies they hire, like United Health, Wellpoint and Aetna, but no big company has moved to use it yet. If just one becomes a first mover, and challenges the status quo along with the baseless charges of “rationing,” this could take off.