David Leonhardt has another in a growing series of great David Leonhardt pieces on the nutty and dysfunctional nature of “fee-for-service” medicine in which doctors are paid for doing stuff rather than for treating illness. The problem, however, is that to totally change how medical professionals get paid would be a big disruptive change, and I see no sign that the public really wants such a change. As Leonhardt says:
More than three in four Americans are “very satisfied” or “somewhat satisfied” with their own care, according to the latest New York Times/CBS News poll. But a substantial majority also say that the health care system needs fundamental change and that rising costs are a serious threat to the economy — a view that economists strongly share.
Thus the political challenge facing any effort at an overhaul: Americans say they want change, but they also want to preserve their own status quo.
I just don’t really know what one is supposed to do in the face of public opinion data like that. Opting for the Barack Obama approach where you focus on reassuring people that the status quo won’t change too much seems like a smart play, even though the case for changing things a great deal is very strong.