The fundamental problem is fee for service regardless of the quality of that service.

Reader comment on: Robert Samuelson on Medicare Costs

Submitted by lyle (United States), Aug 22, 2012 19:06

Fee for service creates at least an apparent conflict of interest as a medical provider appears to be incented to provide more services. Now in the "market" solution in means the patient has to spend the time pushing back against this desire for more services to be rendered, which is contrary to the way patients have been taught to behave. Fee for service means if options exist always pick the one with the highest fee. People don't like the idea of for example you would pay $x copay if referrred to a specialist and $x+$y if you go without a referrral (which IMHO makes a lot of sense).

So it would take a very serious re-education campaign to tell people to push back against physicians advice and require a good justification, and given how little most people understand about anything likely unsuccessful. The set of market solutions requires engaged informed consumers, and if any thing the recent crisis teaches us that in many areas consumers are not so well informed.

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