You hit on a lot of the right ideas here. Fundamentally, unless we are willing to revisit Medicare and Medicaid, a political non-starter at this point, we won’t fix anything. Not because they are bad ideas, but because all of the administrative cost in healthcare is based off Medicare in one way shape or form, particularly its fee schedule. Additionally, one thing we’ve learned from the ACA, is that just because you have more insured patients, it doesn’t mean cost will be reduced. Essentially, if you are a figurative (or literal) car wreck, you are expensive to treat. Medicare not kicking-in until 65 means most folks have already devleoped poor HC consumption habits. That is a cultural change we need to instill.
One element you also need to incorporate is the regional consumption of healthcare or the cost of trying to physically move patients across the country to receive specialized care. HC is not a commodity that can be ordered on Amazon. For the large majority of Americans, traveling outside certain boundaries to receive care is not realistic. Even if I could receive more cost-effective care, if its isn’t 5–10X times better, I’m not going to go through the hassle. It’s not dissimilar to disrupting any industry. There is actually an argument to suggest that within regional hubs, competiton among healtchare providers is not cost effective, as inevitably one provider gets better outcomes (at lower cost).
Additionally, our cultural diversity is also a contribution to our cost, mainly because the scope of diseases we need to cover for most of the country is quite a bit more robust than almost any other country in the world. That is one arena that is often overlooked, particularly when comparing our cost/capita to other developed countries.
I started off being very skeptical of the article, yet you closed strong and there is something to work with here.