I am reading a lot about the US healthcare system these days, as I’ve been doing for the last several years. The conclusions I am reaching are: 1) Patients don’t like it, 2) Doctors don’t like it, 3) It needs to be changed, but, 4) Nobody seems to like the initial steps taken to change it. Almost everyone agrees that the system is expensive, inefficient, confusing, demeaning, and frequently inhumane. Accountable care organizations, Patient Centered Medical Homes, electronic health records, and quality-improvement initiatives of all sorts have thus far succeeded in irritating the clinicians subjected to them without making things much better. The administrative people in charge of healthcare insist that these failures are just a sign that they need more power to build a better healthcare system. The question I would pose is, do we need a healthcare system?
I am not questioning the need for healthcare. I may disagree with some things that are done in the name of healthcare, but I don’t dispute that it is overall a worthwhile force for good. I think also that we need a system for spending Other People’s Money for healthcare, whether that money is collected in the form of taxes or in the form of insurance premiums. Years ago we tried just collecting the money and letting doctors and patients spend it without much restraint, and we have been living through a three-decade backlash against this experiment. It turns out that when doctors are allowed to make money on the treatments they recommend, and patients do not have to spend their own money on these treatments, a lot of money gets spent. Then the payers, Medicare, Medicaid, and all the insurance payers try to rein in an inherently irrational system by imposing mountains of paperwork for the purpose of second-guessing the decisions of doctors and patients. This is the system we have, such as it is, and while it might be improved I don’t think it can ever be completely reformed.
There is an alternative, though, to the healthcare system: private transactions. Pay for the healthcare you find valuable, delivered by a doctor you trust. This is no more a system than buying groceries is a food-acquisition system. Allow yourself to decide what you want from your healthcare, not what your insurer wants for you. Contract with a doctor whose only goal is meeting your needs, undistracted by the bureaucracy of the healthcare system. Most people do not need a healthcare system most of the time. They just need healthcare.