A Fantastic Article. Should be required reading for all.
As a follow up, I’d love to see an examination of how some of the countries of the world tackle the problems / trade offs you elegantly described above. Sort of let’s look at Canada (then Germany, then Japan) what works really well, where is there trouble etc etc.
And of course there is the cost problem.
We in the US pay way more than any other 1st world country for decidedly mediocre results. My own crazy idea is that the Federal Government should stop caring what providers and hospitals actually do (save the ICD-10 codes for the epidemiologists) and just pay per-diems. X amount for an hour of emergency room time, Y amount for surgery time, Z amount for a day in the hospital etc with an effort to have somewhere between 12–48 categories. And that’s what you get. It’s up to the Hospital / Provider to figure out what provides desirable outcomes for the least cost. To sweeten the deal, the Hospital might be entitled to a bonus payment if the patient in question leaves the hospital under their own power after a day in the Hospital &/or a bonus payment if the patient in question is still alive one month later.
The ultimate goal is to have clear pricing for all up front (as opposed to the double-secret pricing that we enjoy today). There are definitely others paths to that goal and that also would be a great topic for further analysis. Just sayin’ 😉 .