[samirunni]

“Standardizing an interface between health care providers and insurance companies would be a huge win. No matter how badly designed, it would be better than the current mess, and save several percent of US GDP.”

A new regulation was actually proposed by the federal government a year ago to do that: https://www.cms.gov/priorities/key-initiatives/burden-reduct...

There’s also a new program to reduce fragmentation for dementia care in particular: https://www.cms.gov/priorities/innovation/innovation-models/...

Solving the sorts of problems highlighted in the article (from 2017) is well-recognized, by elected officials in 2023, as a priority of their constituents.

However, neither of the initiatives linked above will systematically address the underlying issues, which are:

1. Conflicting and overlapping objectives between federal, state and local governments, as well as between the different branches of government.

2. Partially privatized administration of government programs, such as Medicare. This inevitably results in further conflicts of objectives, and incentivizes gaming the system.

3. The only real way for the government to learn from failure, and adapt to it, is by creating a mountain of new regulations, which just makes everything more expensive / take longer.

4. Extreme caution, in regulated industries, around sharing information with external parties, due to liability concerns. This drives further consolidation.

[antisthenes]

None of those issues address the elephant in the room.

If you dismantle the incumbent system and introduce efficiencies that bring US health care spending in line with other developed countries, millions of health insurance workers would be out of their [parasitic] jobs. Which is politically untenable.

The underlying issue is incentive incompatibility. The health insurance industry is a behemoth 10x the size of the automotive industry, for example. You can imagine what kind of lobbying power they have as a result. And they are not interested in anything that destroys their jobs.

[nickff]

Not the TLC, but I agree with you. The biggest costs in healthcare are not insurance company or hospital dividends, or even pharmaceuticals. The biggest costs are the wages paid to doctors, nurses, and administrators. The sad part is that very little efforts seems to be directed to improving the patient experience, such as might be accomplished by introducing patient advocates or guides.