Creating Accountable Care Organizations is meant to improve care and help cut the costs of the world’s most expensive healthcare system. But such attempts run into a huge barrier caused by the fact that  U.S. physicians, who are used to making far more money than their equivalents in the rest of the world, and hospital executives strive to stick to the fee-for-service approach that has made them so affluent.

Consider Cornerstone Health Care, a large physician group in North Carolina, that made a big bet a few years ago when it turned itself into an ACO.

As a New York Times story noted:

“Cornerstone’s experience illuminates just how tough it can be to overhaul the way medical care is delivered, even when the change is a priority for doctors and the government. As Cornerstone learned, hospitals and doctors frequently fight the changes, because they believe they can make the most money under a fee-for-service model.”