Hmm... I'm not sure if that's supposed to answer my question or not.
In any case, I agree that health care providers should be working on better 'systems' that provide a lower-cost, higher-value service. The principal problem is that they have no incentive to do so. We've allowed the entire health care industry to regulate itself out of all sane market pressures.
We've created a 'system' that insulates patients from financial concerns. For the most part, you either don't have insurance and you can't afford the inflated costs at all, or you do have insurance and you don't really care what the doctor is charging - because you're not paying.
That's what I find most disturbing about your perspective. The preoccupation with 'payers' seems to rest on the assumption that there are only two ways to pay for heath care - insurance or government. That is THE problem in my view, and fixing it entails removing the aspects of the 'system' propping this up.
The missing piece in all of this (and why there is no meaningful incentive for providers to implement the kinds of reforms you suggest) is a motivated health care consumer. As it is, patients have virtually no incentive to look for bargains, and doctors have virtually no incentive to provide them. This calls for two reforms that I don't see in your list. First, we need to remove all the tax and regulatory policies propping up employer-provided, low-deductible, group health insurance. It's a failed model and is only hanging on because of the privileges afforded it by state intervention. Second, we need to remove the regulatory cruft preventing people from seeking better alternatives.
This is fundamentally different than the systemic approach (as you've defined it). It is based on the notion that, left to their own devices, people are rational. Ultimately, we can't afford what we can't afford, and health care providers - if they want to stay in business - will find a way to provide health care at prices people can afford. But only if we let them, and only if the people getting health care are the ones paying for it.
In any case, I agree that health care providers should be working on better 'systems' that provide a lower-cost, higher-value service. The principal problem is that they have no incentive to do so. We've allowed the entire health care industry to regulate itself out of all sane market pressures.
We've created a 'system' that insulates patients from financial concerns. For the most part, you either don't have insurance and you can't afford the inflated costs at all, or you do have insurance and you don't really care what the doctor is charging - because you're not paying.
That's what I find most disturbing about your perspective. The preoccupation with 'payers' seems to rest on the assumption that there are only two ways to pay for heath care - insurance or government. That is THE problem in my view, and fixing it entails removing the aspects of the 'system' propping this up.
The missing piece in all of this (and why there is no meaningful incentive for providers to implement the kinds of reforms you suggest) is a motivated health care consumer. As it is, patients have virtually no incentive to look for bargains, and doctors have virtually no incentive to provide them. This calls for two reforms that I don't see in your list. First, we need to remove all the tax and regulatory policies propping up employer-provided, low-deductible, group health insurance. It's a failed model and is only hanging on because of the privileges afforded it by state intervention. Second, we need to remove the regulatory cruft preventing people from seeking better alternatives.
This is fundamentally different than the systemic approach (as you've defined it). It is based on the notion that, left to their own devices, people are rational. Ultimately, we can't afford what we can't afford, and health care providers - if they want to stay in business - will find a way to provide health care at prices people can afford. But only if we let them, and only if the people getting health care are the ones paying for it.