Winston Churchill famously said that democracy is the worst form of government . . . except for all the others.

Apparently Americans feel that way about Medicare’s traditional fee-for-service physician compensation schedule.  Everybody complains about it, but nobody likes any proposed changes.  That’s clear from the reaction to the proposed 2015 fee schedule.   To date, CMS has received over 2,000 comments on the schedule, due for release by November 1.  And most of the comments are negative—some bitterly so.

Here’s a sample.  MedPAC, which advises Congress on Medicare spending, objects to adjusting payments based on quality of care rather than cost.  In fact, according to MedPAC, “it may be impossible” to measure the quality of an individual physician’s care.

You probably thought that information and transparency were good things.  But the American Academy of Family Physicians warns that patients may be overwhelmed by having too much quality information available online.

The insurance industry’s take on the proposals?   America’s Health Insurance Plans says the proposal to pay for time spent outside of actual patient visits—say, in managing the care of patients with two or more chronic conditions—“presents an opportunity for fraud, waste, and abuse.”

The American Hospital Association isn’t happy, either.  Why?  Because the proposal includes data collection designed to help CMS get a better grip on a trend it’s deeply worried about: hospitals buying physician practices and then billing Medicare at hospital (i.e., higher) rates for the same service.