As Republicans are fond of arguing, messing with an industry that makes up a sixth of the economy is dangerous business, and they’re right.The bill in the U.S. Senate today won’t fix anything, and will only screw up what we’ve got. What we’ve got, is a system in which medical professionals, and just as importantly, medical systems are compensated not necessarily in proportion to the amount they help patients but by the number of procedures they perform on patients, whether they are helpful or not. Even in the best of circumstances, such a system must lead to some degree of abuse. Some of it is undoubtedly due now to “defensive medicine” with unnecessary tests and treatments ordered only to avoid law suits, but much more must be attributed to more subtle and less cynical factors. If you’re a doctor who knows how to do procedure A for ailment Z, you’re likely to prescribe that treatment because it’s familiar and has worked in the past in similar cases. But at least one study has found that treatments for specific ailments differ by geographic location, not by the appropriateness for the ailment. In one town doctors with specific training or available equipment tend to use those resources. In a town 100 miles away, the preferred treatment will differ for the same reasons. This strongly suggests that the current system, which provides incentitves for performing procedures as opposed to successful treatment, needs much more fundamental reforms than the current tinkering in Congress is likely to accomplish. Congress and the Obama administration should start over.