The author makes a good case for ending healthcare monopolies by ending certificates of public need.
It makes sense to the extent that non-hospital testing and procedures are much cheaper.
Yet, the real culprit is fee-for-service. We have coding systems that are so complex that it take a 6 month course to get a certificate for competency. And the whole concept is to maximize billing by a convoluted method of charging (overcharging sometimes) for every possible pill, device, touch, consult, wink and nod.
And this has no relation to efficacy. Warranties are heard of. Over treatment and over diagnosis is handsomely rewarded. To put it more bluntly and cynically, a cured patient is a loss of income.
I believe the vast majority of doctors, NP’s, etc. would prefer a better system because they are dedicated to the profession of alleviating suffering. However, the consolidation and incorporation of large healthcare groups that are bought up by investors creates a buffer that clouds that patient-caregiver relationship.
Tales are told of ancient China where local physicians were paid fees by all the residents to keep them healthy. If one got ill, the payment stopped until cured.
Simplistic? Sure. But not without merit.
We are kind of doing this now through insurance which is essentially prepaying for care, but with costs spread among large populations. But the providers are paid for services regardless of need or outcome. Payments don’t stop when a covered person gets ill. Instead, they increase and continue as long as he is sick.
How to shift to a more results oriented system was addressed by ACA. But it never got a chance to improve.
And it is going to get worse. Healthcare organizations are consolidating to a degree that insurance companies are at a huge disadvantage for negotiation. It used to be that insurance companies would put providers in their network for a good price. Now, with the best providers joining corporations like Sentara, insurers have to pay to get the good docs in their network.
Good for business, bad for healthcare costs.
Every “reform” that has taken place or offered, including ACA (and the Libertarian one by Don) is essentially focused on insurance. Fine, except that insurance merely reflects the costs, prices really, of healthcare without addressing the problem.
And now that insurance is losing the whip hand in major regions, we can no longer expect insurance to be an effective advocate for lowering healthcare costs.
So what to do? Eliminating COPN might help, but with the powerful monopolies already in place, it might be a case of closing the barn door after the horses are gone.
A start might be to look at auto repairs. Most go by a book for set prices. Warranties are part of the deal. Allow more independent clinics and diagnostic facilities and loosen laws regarding NP’s.
And the perennial bugaboo of regulatory pressures as just about all other nations with less costly and universal or near universal coverage have.