The U.S. healthcare system is a dumpster fire. Per capita, the U.S. spends the most in the world on healthcare, almost double the amount of similarly developed nations such as France, Sweden or the U.K. At the same time, the U.S. has health outcomes that lag significantly below these nations in metrics such as healthcare access and quality (HAQ), disease burden (disability-adjusted life years, or DALYs) and pregnancy-related deaths.
What is driving such a disparity between healthcare spending and health outcomes? That’s a complex question. Part of the reason lies in the atrocious diet and lifestyle creating obesity and chronic disease in the American people at unprecedented rates, but much of the blame lies in a broken healthcare system that is failing to deliver value to patients.
Many books can and have been written on this complex topic. In my opinion, the fundamental problem is government intervention, which has reduced free-market competition with crippling consequences.
If a plumber or accountant presents an unreasonably large quote or provides poor service, they will simply fail to win ongoing business. Not so in healthcare, where cartels of insurance companies and hospitals collude to fix prices and maximize profit.
Overregulation and market intervention by government has provided fertile ground for regulatory capture and the consequent proliferation of an entire class of profiteers, grifters and freeloaders who make money standing between patient and physician. This rent-seeking “Medical Industrial Complex” includes the medical insurance industry, corporate hospital groups (including “not-for-profit” hospitals) and the pharmaceutical industry, all of which have benefited enormously from censorship of the free market, the buy-out of physician-run practices and the wholesale centralization and corporatization of medical care.
This has resulted in a horrendously misaligned set of incentives and quite frequently, a principal-agent problem between physician and patient.
For physicians, it leads to unnecessary pharmaceutical use, unnecessary surgical intervention and ignorance of best-practice lifestyle medicine that could address and reverse chronic disease at its root cause. It also means loss of autonomy as physicians are often forced to seek approval from insurance companies prior to initiating care.
