Organized medicine’s persistent demand for high payments is one factor that contributes to the rising costs of health care. The profession’s longstanding preference for private and fee-for-service practice has pressured payers to increase reimbursement rates in fee-based systems; and it has stalled, thwarted, or otherwise co-opted attempts to contain costs in other payment systems. Yet what doctors want in fact varies. This comment revisits classic comparative studies of organized medicine in the advanced democracies to highlight two underemphasized findings: (1) physicians’ financial preferences can deviate from traditional expectations, and (2) the structure of the organizations that represent doctors can shape whether and how those preferences are expressed. These findings remain relevant today, as a discussion of contemporary American health politics illustrates.

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