The smiling face of an ophthalmologist interacting with a patient on the pages of The New York Times should be a positive image for the profession. Unfortunately the article that accompanied it was describing why the surgeon, along with countless other physicians around the country, made the decision to close his practice to all but emergency cases in the face of this year's game of musical chairs over proposed cuts in Medicare physician reimbursement. Refusing to care for patients. I'm betting that's not one of the reasons any of these doctors went to medical school.

When the music stopped this time around, left standing and fighting for the one remaining chair were physicians, facing a 10.6-percent cut, and the private Medicare Advantage program, facing the loss of support that was intended to be temporary right from the start of the program. Advantage, physicians, at a cost of millions in lobbying and advertising dollars. At least this time.

Crisis averted, the annual (now becoming semi-annual) chorus of voices proclaiming what's wrong with the Medicare funding dies out and everyone gets back to work, one step closer to the edge of  the cliff.

Meanwhile, quietly humming in the background, regulators and bureaucrats continue to hatch what are supposed to pass for long-term solutions. Universal adoption of electronic medical records. Evidence-based medicine. Pay-for-performance. Only now that these solutions have been around long enough to actually study whether or not they work, it seems that every month brings another report of their flaws. This month's installment comes from a study reported in Health Affairs that suggests that unless there's an adequate incentive for the physician, P4P initiatives may not have much effect at all on quality of care. This follows earlier studies suggesting that widespread adoption of EMR may be slowed by physicians' perception that the systems are not worth the cost in time and dollars to implement them.

There are many, many talented and bright people working on these issues and the last thing I would suggest is that there's a simple solution to any of it. But it's also clear by now that there are far too many people who lack the will to address the difficult choices that need to be made to fix this mess. We elected them. And we re-elect them. And every year, the song and dance is the same. How many more years do we think we have?