As part of an Obama­care initiative meant to reward quality care, the Centers for Medicare and Medicaid Services (CMS) is allocating some $1.5 billion in Medicare payments to hospitals based on criteria that include patient-­satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?”

To many physicians and lawmakers struggling to contain the nation’s opioid crisis, tying a patient’s feelings about pain management to a hospital’s bottom line is deeply ­misguided––if not downright dangerous. “The government is telling us we need to make sure a patient’s pain is under control,” says Dr. Nick Sawyer, a health-­policy fellow at the UC Davis department of emergency medicine. “It’s hard to make them happy without a narcotic. This policy is leading to ongoing opioid abuse.”

That abuse has led to a full-blown crisis. Since 1999, fatal prescription-­opioid overdoses in the U.S. have quadrupled. According to the CDC, more than 47,000 Americans died of a drug overdose in 2014, a record high, and more than 60% of those deaths involved an opioid. U.S. emergency rooms now treat more than 1,000 people every day for misusing prescription opioids.