For the last couple of weeks there has been increased interest in reforming the U. S. healthcare system. I think many of the pieces I’ve read have been well-intentioned but miss a key point. This piece by Deane Waldman at RealClearHealth certainly fits that description. Here’s a snippet:
News media are replete with stories about the killing of UnitedHealthcare CEO, Brian Thompson. While the murder mystery elements still dominate, a constant subtext is the perpetrator was angry at greedy insurance companies like UnitedHealthcare and frustrated that care is unaffordable and inaccessible.
With Trump in the White House and with the DOGE (Department of Government Efficiency) advising him how to improve efficiency of federal activities, radical reform may be possible, transforming healthcare to become affordable and accessible. Might there be anyone opposed to such transformation?” The surprising answer is, YES!
Who are these people? There are three reasons why some would resist: self-interest, wrong reform, and fear of change.
I think there’s actually other reasons, even a group of related reasons, that there would be resistance to change in our healthcare system including longterm trends within the practice of medicine. Dr. Waldman is pretty forthright about how he thinks our system should be reformed. I think he’s engaging in wishful thinking and introducing advertising and price competition into healthcare are unlikely to result in the cost savings that are necessary.
I would like to open this post up to a conversation about reforming healthcare and air some of my own prejudices about it. I don’t believe that any conceivable reform will result in more, better healthcare at a price we can afford unless the incentives are changed and any attempt at changing the incentives in healthcare will be fought to the death by all of the stakeholders, e.g. patients, providers, insurers, employers, etc.
Please don’t say “well, other countries pay less for equivalent care so it must be possible”. That’s a cop out. Say what you think should be done and how it can be done. There are a number of things that should be kept in mind. First, there is no country that is actually comparable to the United States. There is no country that is as large as the U. S. and as rich as the U. S. and shares a 1,600 mile land border with a country with a median household income a quarter its own.