Health insurance is undisruptable, unless you’re ready to light billions of dollars on fire over several years, or take decades to do it by growing extremely slowly.
The provider side is equally difficult, but I think it’s at least doable. Though you’re still screwed having to deal with CMS or insurance carriers.
There is a fifth one that imposes costs: our comprehensively unhealthy food, health, and lifestyle in America that capitalism feeds upon with addictive high-margin food and drink, with overworked workers that can barely have time to raise kids (our healthy demographics are due to immigration) much less a healthy lifestyle. The entertainment complex certainly doesn't help either.
Providers: you need comprehensive family care to avoid specialist care being needed, an increase in supply of doctors, decreasing their educational loan burden (which strongly incentivizes specializataion, and a system that involves specialists). I think advanced AI systems can do much more day-to-day tracking and diagnosis/information, but of course that is a personal information nightmare. Actually I don't mean advanced. I think current AI is plenty good enough. Unfortunately only insurance companies will employ these systems or pay for them.
Insurance: Probably need a medicare-for-all option. We were close to this with Obamacare but FUCKING JOE LIEBERMAN killed it. Exhibit A in why the Democrats with full control of government will never get anything done.
Drug/Device companies: reduce patents, I don't know, maybe allow price negotiation (which is just mind blowing in a "free market" economy), reform the FDA to make bringing drugs to market cheaper.
Lawyers: caps caps caps so there isn't costly malpractice insurance. Maybe would also necessitate a federal review board to weed out "bad doctors".
But the biggest is probably governmental direction to actually get people to be able to eat and live active lives. Maybe GLP-1 will help, but the quiet time bomb of increasing obesity in Americans each decade is probably a sneaky large amount of our costs.
Otherwise, on the nihilistic side, keep doing whatever our society is doing which is causing men to kill themselves in huge rates (soma ... uh... I mean opioids were also doing this as well) before they reach their ultra-expensive late stage of life.
Anyway, none of that is happening (except, sadly, the nihilistic solution is the most realistically happening).
Maybe setup huge provider networks across the border in Mexico and Canada served by high speed transit, so large portions of the world get health maintenance in functioning health care systems, and only do hospitalization and emergency care here?
We recently tried this with some vaccines and now a large segment of the population is now vaccine-hesitant.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257562/
> Lawyers: caps caps caps so there isn’t costly malpractice insurance.
Caps don’t always result in improved health outcomes.
https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?p...
> Maybe would also necessitate a federal review board to weed out "bad doctors".
This exists; each state medical board has a procedure for reviewing medical licenses.
Forced vaccination was the problem here.
Uh, definitely not. The drug discovery and trial process is every bit as complex and expensive as it is for a reason. If you're serious about lowering the cost of getting compounds through the pipeline the first thing that should go is private equity's growing chokehold on the provider practices that perform clinical studies.
But, a lot of people don't like Kaiser. You have to be ok with getting good enough care, and not really be trying to seek 'the best' care. Integration is so nice though. I'm sure Kaiser never puts you in the situation where the Dr says I'm not sure which drug will be covered, let's try A, the pharmacist says A isn't covered, ask your Dr to write a script for B, and your Dr doesn't answer the phone so you have to decide to either pay $250 for A or wait over the weekend to start your kid's treatment.
If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape.
Eliminate other private health insurance and if people want above and beyond service they can negotiate directly with providers and pay out of pocket for that.
It's hard to do that without turning it into the NHS.
I certainly don't want a free for all system like the US has (and I suspect the Tories want) but it isn't great at the moment.
You can but as soon as something gets serious they dump you back on the NHS.
Politicians - mostly the tories but Blair's government take a lot of blame too - have defined "not privatising the NHS" as only meaning keeping it free at point of use. But in the background, NHS trusts have been forced to sell land and buildings that they used to own and rent it back from the new private owners, and many areas have seen both staff and equipment privatised, from agency staff (where instead of hiring cleaners or nurses or whatever, they instead hire agency staff, where the hourly cost to the NHS is double or more what an employee would cost with most of that increase going to the agency companies not to the workers) to private hospitals (where instead of investing in a new operating theatre, or whatever, they pay to have NHS patients operated on in private hospitals), etc.
The NHS is far from perfect, but the lesson we learn from those imperfections shouldn't be that nationalised healthcare is bad, but that underfunding it and then using that underfunding to justify privatising lots of stuff in the background is not a good way to run a nationalised health service.
The root problem is that many politicians would like to see the NHS fall to pieces so that an American healthcare system can create lots of opportunities for companies to make money, but because the NHS is hugely popular it would be political suicide to make that an official policy, so instead they've taken this approach which not only creates these short term opportunities for companies to come in and profit as mentioned above, but also gradually erodes the it's popularity with the long term goal being that eventually it won't be political suicide to say "Look the NHS is a failed experiment, we need to replace it with American style private companies and healthcare insurance".
Linky?
Doctors: It's like working for any other hospital; it's not bad.
I was never healthier. The other Kaisers in Oregon aren’t geographically collocated so there’s less of an effect and they’re far away from me so I don’t use them anymore, sadly
But it all starts with voting for people who want to fix it, and not for people who just want to burn it down or maintain the status quo.
Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons.
As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.
The providers have leverage and the ones with the most will screw you over unless you’re big enough to throw some weight around.
I honestly don’t see much change unless the government comes in and sets new rules that actually make sense.
Health insurance is undisruptable
The same applies to insurance. You can't take crap contracts that don't work for you, so maybe create a contract of your own based on 1st principles and going back to the definition of insurance.
Or is it that the Healthcare industry has tilted the government into making rules that favor the status-quo?
Ultimately, it is the government, not the industry, that sets the rules, and it is the government, not the industry, that is accountable to us.
Even without the argument that ultimately voters are responsible for the government they get in a country with free and fair elections like the U.S., health insurance is a very direct example of voters explicitly opting for a worse option.
The ACA was being written in 2009 and 2010 and the argument was whether it constrained the insurance industry too much or not enough. The very specific policy proposal on the table was the public option which would have allowed the govt to offer an insurance policy that would have effectively set a floor to the quality of policies the healthcare industry could offer and a ceiling on the cost.
And the 2010 election fell right in the middle of the debate and American voters overwhelmingly chose the politicians arguing against the public option and for fewer restraints on the insurance industry.
Beyond that you can just look at every other developed country in the world, and all of them have better healthcare because their voters constantly vote for politicians who offer better healthcare policy, as opposed to the U.S. where voters choose the opposite.
It's not an easy market to jump into; you spend a huge amount upfront on site construction (particularly if you're building standalone clinics outside of existing medical buildings, which is not unusual for urgent care), labor cost and complexity is high, and reimbursement cycles are long and painful. Healthcare chains scale like retail, not like software, with all the attendant cash management problems.
It feels like they did offer a superior service with lots of effort put into getting into the community, but I question both their decision to try and build a custom EHR -- yes, EHRs suck, but once you start building your own, you're no longer a medical services company, you're now an EHR company -- and not to pursue a regional-centric expansion strategy aligned with local health systems via contract or JV, instead choosing to build a small number of clinics across the country, which goes against proven successful buildout strategies in healthcare.
It's a shame they've gone under -- again, superior service, obviously a lot of care for their patients -- but "we went under because of cash management problems and inappropriate growth strategy" is a pretty standard story in the healthcare world.
Children are an attractive selling point for a company in the same way as cancer of some altruistic goal. Though here, although elder care exists, to me that seems like the market to disrupt and minimize costs in.
Healthcare insurance in the US is heavily subsidized, and no number of revolutionary care delivery models will put you on level terms with the behemoth of US govt insurance subsidies.
Your only hope as a non-provider is to come in with your own a-la-carte insurance that is able to take those subsidies, while you set your moat and innovate in the delivery front.