I wrote hospital medical software for 20 years passing on way better pay because I wanted to make a difference. And I gave up because the system WANTS to be how it is today. Everyone in medical is CHOOSING to make it this way, then claiming 'ah it's too big, it's too complicated, we can't change it'. Americans being to scared to call an ambulance means emergency care has completely failed them, not a small little thing to be brushed off. Americans are making hard choices about medical care every day already.
The system can't want anything. It isn't even really a "system" in any meaningful way, in the sense of being a unified entity working towards a common goal. US healthcare is just a bunch of disconnected people and organizations pursuing their own interests, often in conflict with each other. Any major improvements will require changes at the federal policy level to better align incentives with desired outcomes. This is hard because we collectively can't even agree on the desired outcomes or how to measure them. I mean at a high level most people think that everyone should have convenient, affordable access to high-quality care but once you get into specifics everything gets complicated and making trade-offs which disadvantage some voters is unpopular. Like should we spend $100K to give a terminal cancer patient another month of life? Should surgeons make $700K per year?
It's easy to complain and cast blame. And we should certainly cut out waste and abuse where we find it. But that won't significantly move the needle on overall system costs. The problems are much more fundamental.
Well said. That this could be equally applied to the US as a whole likely explains subsidiary disfunctions.
Commercial health plans have conflicting financial incentives. Most of them no longer provide much insurance (in terms of bearing financial risk) but rather primarily act as administrators for self-insured employers. So while payers can potentially boost short-term profits by paying out higher claims, employers comparison shop between competing health plans every year. Your HR department would happily switch from Aetna to Cigna (or whatever) next year if their analytics forecast shows that would save a few dollars on expected claims.
Ambulance fees are a mess but those represent a tiny fraction of overall US healthcare spending. Some reform there would be a good idea but that wouldn't do much to reduce costs.
Significant systemic cost reductions will require some mix of lower provider wages, care rationing, and reduced spending on new drug and device development. Countries with more socialized healthcare systems are more financially efficient in some ways but they also just do less stuff: less drug development, longer queues for advanced treatments, underpaid doctors (relative to market wages), care restrictions based on QALYs (or similar metrics). Complaints about payer profits, while perhaps somewhat legitimate in certain cases, are largely a distraction from more fundamental problems. That's just basic math dictated by the cashflows. There are no simple solutions and we're eventually going to have to make hard choices. No one wants to face this reality.