Originally Posted by
mitchless
The best descriptors for health care in the USA is "rent seeking" and "bureaucracy."
Physicians are highly educated and credentialed individuals, and that education and credentialing costs a lot of money. As a result they want a lot of money for their services. Consumers, on the other hand, want to pay as little as possible for the services of those physicians. Rather than negotiate this tension and meet in the middle somewhere like every other good or service, a variety of third-party payers have emerged. These third-party payers then become gatekeepers between physicians and their patients, and decide how much physicians get paid and how much patients will pay. Left unsaid is that the third-party payer also decides how much of that transaction they keep for themselves -- that's the rent-seeking.
It doesn't matter if the third-party payer is a not-for-profit charity, for-profit insurance company, co-op, government agency, or some other arrangement. This is how it works, and that's the bureaucracy. Almost all of the "solutions" proposed are variations of third-party payers. Some of them are fourth-party services designed to help you navigate the third-party services. Very few "solutions" get at the root of the problem. One that I'm aware of is called "direct primary care." This is the apparently novel idea that a patient should directly pay their primary care provider for the services provided, usually as a monthly subscription.
NOTE FOR EVERYONE: I am well aware that the service offerings around medical care are far more complex than I have expressed above. The word "physicians" above could be replaced with "service providers" to more accurately reflect the state of the market. This is a model and the complications that arise from hospital systems, pharmaceutical companies, imaging companies, etc. None of that changes where all the "action" in this space is going on -- it just changes the size and number of players in the different roles.