A Podcast on the American Health Care System
Her assertion, documented in the book discussed in this podcast, is that the American Health Care System has never been a free market system.
Instead, the American Medical Association, which was far more powerful in the 1900’s through the 1950’s than it is today, fought hard against government intervention–but also fought hard against any free market experiments that were taking place at the time. By using licensing of doctors and laws they helped to push through which limited the scope of practice of anyone who was not a doctor to practice medicine, the AMA fought to preserve an outdated 19th century model of a country doctor taking care of his patients. (They also used their control over licensing to prevent blacks and women and other “undesirables” from practicing medicine.)
And when the 1930’s rolled around, the AMA fought the introduction of government intervention by inventing the current system of health care insurance funded health care, basically out of whole cloth, as a compromise against socialized medicine.
Because of this we have had no incentive to experiment with different payment systems or to experiment with ways to help control costs. Further, as the AMA has lost power, it has essentially ceded power to insurance companies (whom they fought against even after the 1930’s), and to the federal government who has been engaged in a series of “reforms”, all the way up to Obamacare.
The author concludes we need to come up with new ways to innovate with ways to deliver health care in this country. She also concludes that the current insurance-based health care system is so throughly broken that perhaps transitioning to a single-payer system (not based on the current Medicare/Medicaid systems, which are deeply rooted in the broken insurance payer model) may be the only thing left for us.