> However, if you have a "flat fee" dentist/doctor you could be now encouraging the opposite - do the minimum work necessary to get done with the day. It's hard

> However, if you have a "flat fee" dentist/doctor you could be now encouraging the opposite - do the minimum work necessary to get done with the day. It's hard to legislate "be a caring, honest professional" but we can at least remove some of the incentives to not be. First of all, we know that it does not encourage the opposite, see Germany pre 2007 or any other country where where health care is not run like a business but let's look into it in the abstract: Humans love helping other humans. The "be a caring, honest professional" part is a product of intrinsic motivation. The idea that it needs to be externally motivated is extremely harmful. That is not how humans work. Yes, some people get into medicine for the social status, the power or simply money but that is not the majority and we need to a way to filter out those that are full on narcissistic but the vast majority really just wants to help people. > The best dentist I ever went to had a picture of his airline pilot wife on the wall - and from how he treated his patients and charged, I got the feeling he worked because he liked to, not because he needed to. You hit the point here. He doesn't need any external drive to do his best, he just needed the opportunity. It's similar to software developers wanting to write good code. They will strive to do so given the chance and ability even when management discourages and punishes them for that, as is often the case. (Well, "good code" might be subjective but you get the basic idea, humans want to do a good job.)