The primary flaw in Medicare is that the “entire pool of resources from which all physician reimbursement is drawn is a fixed pie. It grows only as fast as the Medicare population increases and depends, to some extent, on the growth of the economy.” The result of that “fixed pie” is to create “a zero-sum game” in which more payment to one, reduces the payment to another. “The only economic reward for the physician is to provide more services or higher complexity services. Thus, every other physician’s reimbursement is adversely affected ... In maximizing their own benefits, the participants in the zero-sum game impinge on each other.”

— John Mayer Jr., MD, president of the Society of Thoracic Surgeons (TCT; Chicago) discussing the flaws of the current Medicare payment systems in his presidential speech, “STS president cites path out of medicine’s ‘zero-sum game,’” pp. 1, 5.