Thought you might appreciate this. The author is a pretty intense econ blogger (much of it right at or beyond my ability to understand the arguments), but here he just unloads in response to the recent Time article about health care costs.
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I haven't read the Brill article yet, but based on the blog post - I get his argument for collective action. But as with most market failures, the public is just so ill-equipped because of asymmetrical info and influence with policymakers.
We've chatted about this issue during the Obamacare debate and other times, but as you said, most of the "proposals" are marginal improvements - and even those are unlikely to pass because of entrenched interests. You probably have thought about more comprehensive fixes, and I'd love to hear about them. From what little I know about healthcare economics, here is my initial list and let me know what you think:
1) Shift from fee-for-service to fee-for-outcome - and along these lines, empower consumers to refuse unnecessary or excessive care. Just as we are constitutionally guaranteed to legal defense, maybe we should be guaranteed a health advocate who represents our personal interests vs. the healthcare providers (who also care about us, but also care about other things)
2) Related to (1) is tort reform because medical malpractice much more lucrative and widespread in the US, compelling some providers to over-prescribe. But along those lines, there should be lawsuits and penalties for over-prescribing too.
3) This one is the most controversial and hardest to achieve (if it's even a good idea), but change the nature of demand - it's amazing that people can live longer and enjoy life more. But we are part of a society with some zero-sum aspects. Keeping an elderly person on life support for a year affects other needy patients. We are constitutionally entitled to pursue our happiness (which usually involves avoiding death), so no laws can apply here. But maybe people should reconsider their life expectations and their resource allocation impacts on society. It's OK to get sick and die when you're old. It's OK to "tough out" non-critical issues. A "good life" does not mean being top performing and discomfort-free all the time. Unless you have a high-deductible crappy plan, over-using resources doesn't hurt the patient, but at scale it does to everyone else. In other words, tragedy of the commons.
4) market-based pricing & more buyer power - there has to be a supplier out there who is willing to sell us gauze for less than $77/box. And for medicare, the VA, or even Blue Cross with thousands of members should be able to negotiate better rates (the whole point of HMOs according to Kaiser and Nixon). But providers and vendors have local monopolies so there is little to no market. Also switching costs can be high, especially for employers choosing insurance. The health-care exchanges won't help much (if at all) because the pools are small and some of the most high-cost customers.
5) Harmonize state laws and health benefits admin - a lot of waste, bureaucracy, and delays regarding the different laws relating to privacy, insurance, benefits payout, taxes, etc. As part of this, there has to be more layoffs and pay cuts in the industry. It's ridiculous that health is 15-20% of the economy (just in the US, and maybe sub-Saharan Africa). It doesn't really make sense today to have >5 major airlines in the US, so why would we have dozens of insurers?
6) Incentivize hospitals and providers to have excess capacity, not fill empty beds with less sick people. Pay them to NOT treat people (when appropriate), because treatment also increases the risk of medical error and infections. This may free up resources to help underserved areas. Like with public schools, shut down or take over poorly performing hospitals and reward the good ones (measured by health outcomes per $ spent, not revenues).
7) Shift medicare spend from end-of-life emergency treatment to daily maintenance and preventative care (do this for younger patients too). Seniors sometime go to the doc mostly because they're lonely, yet we're cutting in-home services. If they feel socially connected, there is some data to suggest that their health improves too. And there will be someone there to take care of the small things before they get big, and take pressure off the elder's family.
8) Change the research grant structure - those who financially benefit from the research should pay back the gov't (at a low interest rate), even nonprofits. Along those lines, shift the emphasis from public-subsidized medical high-tech research to efficiency & outcomes research. Yes, future innovations are sexy and amazing, but probably not cost effective and affordable to many. It's better to focus on using our current proven tech in better and smarter ways. Even improving IT and data collection/analysis would be huge, and much cheaper than the next specialty drug that extends a sick person's painful life for 2 more months. Many docs and hospital admins are notoriously horrible with data. Again, this will cost jobs, but will save lives for less $.
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