So, having been asked 2 times in as many days to talk about actual solutions to health care in this country, I figure I'll write it down. As far as I can tell, there's near a half-dozen ways one could "fix" health care in this country. However...almost all of them are political non-starters. And...the question of what needs fixing is also up in the air. First, solutions. Second, a disputing of the premise.
Statement of the problem:
Health care's share of national income is rising with no end in sight. Unless something is done, very possible to have 30% of our economy spent on Healthcare in 15 years. Furthermore, the additional spending we do as compared to other countries does not appear to makes significant differences in any of the measured outcomes.
1. Do the whole Hillarycare thing...nationalize the payment industry, and then deal with shortages of doctors & new drugs as those activities become less lucrative, and begin to ration care. Explicit problem fixed. Less care, less cost. Potentially not much less health because most expensive treatments are statistically ineffective.
2. Do the McCain thing. Remove the employer subsidy for health insurance. Instead give a tax credit for health insurance (including HSA stuff). Now, it's people spending their own $, and all of a sudden, market forces work. Expect serious cost reductions and less service used.
3. Strip the FDA of it's ability to regulate effectiveness & advertising in drugs. Safety only. Cost of developing a new drug would drop dramatically. Also, devolves power away from established drug companies, and towards upstarts who are better at innovation. Since drugs are our primary method of improving health right now, this solution rocks.
3b. Remove from the FDA the ability to specify prescription only drugs. Feel free to put that category under CDC, so as to regulate such substances as are public health risks if overused.
4. De-cartelize medical services. There is no reason why you need 85 years of schooling in order to splint a broken finger, stitch a cut, etc. Why do doctors have a government enforced monopoly on doing this kind of thing, and why don't we have India-style Bachelor's of Medicine to do simple stuff. Sorry, dumb question. Public choice economics predicts that the government will protect monied interests who can't maintain their advantaged position by virtue of their skills. On the other hand, prices for simple stuff would drop tremendously.
5. De-criminalize medical diagnosis by non-doctors. Current research is pretty solid that a piece of software with a pile of statistical correlations between diseases and symptoms is a notably better diagnostic tool than an actual fallible human doctor with hidden biases. See issue 4.
6. Tort reform. Hard to go here at all because reality is that rich concentrated political interests (trial lawyers) will be in the middle of this, and the result will likely come out even worse than the current situation. If it did work to limit the liability of doctors for good choices with bad results, it might decrease costs a bit.
7. Criminalize our current form of insurance. It is not insurance. And the separation between the provider, the customer, and the payer is causing the growth in health care spending.
Now, the interesting part:
I don't necessarily believe that the problem is as stated.
I'd argue that the problems are that
(a) some people don't get care that is needed.
(b) much care is complex, and it is hard to disentangle what works
(c) much care statistically doesn't help any more than do crystals
(d) innovation is not progressing as fast as it should
(e) growth of wealth is too low: I don't care if we're spending 33% GDP on health if GDP is $300K/y (constant 2009 dollars).
(f) aging is not being treated as a disease that needs curing. (Gratuitous plug).
Those problems...all except the (a)...are all best solved by getting first "insurance" and second government...the heck out of health care.
Pure welfare for (a) works as well as any other civilized solution.
Maybe try Singapore's solution.