Biggest problem: too expensive. Second biggest problem: quality is not always what it needs to be.
Some thoughts on concrete ideas that I think could improve the system at least somewhat (borrowed from many different sources — not my ideas, but any errors in regurgitating them are my own):
1) A change to federal antitrust policy: A lot of hospitals in places with less population density are practically local monopolies that can set any price they want and people generally have no other reasonably accessible option, even for non-emergency care. Allegedly, this is a product of rampant consolidation of hospital ownership. So reverse the consolidation trend. Encourage entry into the market and other forms of competition. Prohibit mergers between hospitals, if those mergers would corner a local market. And besides hospitals, I would say a similar thing for any healthcare market, like dialysis clinics, nursing homes, etc.
2) A change to local health services and perhaps local/state/federal laws if needed: Local
EMS services should offer Uber-type services with maybe one paramedic-type of person in the passenger seat, and encourage (don’t force) 911 callers to use them instead of an ambulance, if their condition does not appear to be one that requires an ambulance. I speculate that this could be a win-win for everyone: the patient gets a much cheaper ride to the hospital than in an ambulance; patients may become quicker to use healthcare services in non-life-threatening situations, which could end up keeping them healthier in the long run; more ambulances are freed up for true emergencies; insurance providers might even be willing to cover these cheaper rides much more frequently than they currently cover ambulances, and they might even increase their willingness to cover ambulance rides when they are deemed to need them (this is me speculating, but I think one current disincentive for covering ambulance rides under the current system is that it would be hard for them to draw the line on which ambulance rides are necessary and worth covering vs. which aren’t).
Unfortunately, those ideas don’t actually significantly change the system for most people, though. And I don’t have a silver-bullet idea that I think would. But to that end, here are some conversations that I think should be had, and could maybe lead in the right direction, but I don’t know enough to properly contribute to them:
1) Alternatives to the patent system. The patent system offers important incentives for innovation, but it also creates years-long monopolies over things like pharmaceuticals, which of course means high prices. Is there a way we could provide the same incentives for innovation, but at a lower cost to society?
2) What unnecessary barriers are there (and should be removed) to growing the supply of medical professionals? Think about barriers at every level, e.g. barriers to studying medicine, training as a resident, practicing as a doctor, and letting RNs or others do things that don’t really need doctors’ attention. An example of the type of thing I have in mind is the likely excessive hurdles that foreign-trained doctors face before they can practice here.
3) On a related note, why is med school so expensive, and what can be done to make it less expensive while preserving or even increasing the training quality?
4) How to appropriately reduce paperwork loads (e.g. by changing
HIPAA?). I have heard that paperwork is a large burden for doctors and other healthcare staff, and while some paperwork is likely necessary, I just can’t rationalize the numbers I’ve heard for what fraction of time doctors and nurses spend filling paperwork instead of treating patients.
5) Should all these “nonprofit” hospitals really be treated as such?
6) Do the
AMA,
APA,
ADA, and other professional associations (and industry groups in markets like pharma and nursing homes) wield too much power over their members’ profession? Should they have more oversight? Who should oversee them, and what should they do to keep these professions well-qualified but without becoming a racket?
7) If the US were to move to having a unified public healthcare system, how should it be designed, and who should design it? Public healthcare sounds great (and much of the country is already on public healthcare), and it’d be hard (but not impossible) for it to cost more than we already spend on healthcare, but at the same time, a unified US public healthcare system would be massive. And the bigger government systems are, the more scope there is for them to create waste, corruption, and inefficiency. So the way it is designed from the start would be crucial in defining whether it is destined to be a net benefit to American health or simply a net drain on our resources. One example of an important element of its design is that I think that keeping a private market for healthcare open, alongside the public option, could be an effective way to keep the public option’s prices, wages, and quality competitive — although I’m speculating a bit here.
Hopefully some of this is helpful. Hopefully I didn’t get too many of the facts wrong
- I’m not a medical professional, I’m just an (almost)economist who has done some work on health policy.
Some sources that I respect and would recommend for more qualified commentary:
https://onepercentsteps.com/
https://www.sensible-med.com/
And many others.
