Right now, Medicare pays doctors by what’s known as fee-for-service: They perform a service, prescribe a drug, and they’re paid for it. Volume determines the cost.

But under a pilot project being developed through the Affordable Care Act, the federal government wants to completely change that system, setting a price for doctors to meet when they treat a cancer patient and rewarding them for beating it.

The hope is that such an overhaul will do two things at once: keep costs under control and improve the quality of care. Those twin goals are the aim of many efforts to revamp the way doctors are paid in the United States, and there is reason to think it could work for chemotherapy.

But this kind of reform is also sure to draw concerns that doctors could be too thrifty and the actual care might suffer as they try to meet their cost goals. The public discourse is just a few years removed from the height of the Obamacare debate, and the rhetoric about keeping your plan if you like it, and death panels. The stakes couldn’t be higher when the diagnosis is cancer.