Why Fee For Service Hurts Us: The Plain Language Version

I’ve had a few conversations recently with elected state officials, and I’m reminded that speaking plain language always helps.  Here goes:

We all agree that fire stations are a good thing, right?

And we agree that we don’t want them to be busy … 

So if the firefighters are always watching Three’s Company reruns, that would be good.  We still pay for the fire station.  We still pay the salaries.  Happily.

Therefore – paying firefighters more for fighting more fires would be silly:  their financial success would align with hardship in the community. 

But this is how we pay medical providers:  more sick people = more $$.


We have a social compact: everyone agrees that we should pay for fire stations (infrastructure) and firefighters (humans) to be ready for fires.  We all pay for this with our taxes.  It’s the most efficient way for us do this.

Shouldn’t we have a social compact that would cause everyone to agree to pay for hospitals and medical offices (infrastructure) and medical providers (humans) This would be efficient and effective.  Then if the medical providers were idle most of the time (watching Three’s Company reruns) – it would be because the community is healthy.  Nobody would complain of reduced revenue due to low volumes of emergency department visits.  Kinda like what Maryland did.  Seems simple.  Why not?