| I think direct care models, in all but name, are probably coming. I might be wrong, but the way federal governance in the US is headed it seems increasingly rather than decreasingly likely. In our region there are already hospital systems that are owned as subsidiaries by corporations that also own insurance companies. These corporations are gobbling up smaller hospitals as those merge and then subsequently get purchased by regional systems. The monopoly in the provision is problematic enough, but it reaches new levels of problems when they are also merging with insurance companies. So for some people, even if they aren't getting direct care technically, they are, because their choices are limited geographically for all intents and purposes to one provider, and their insurance is coming from the same provider. The challenge these direct care models faced, as alluded to by other posters, is in competing with conglomerates that offer a complete spectrum of care. You either cater to people who can afford it, or have to lower costs enough to make it reasonable for people who might not otherwise. The first option limits your customer base; the second is not really currently feasible given government regulation and how it inhibits competition in delivery models. I worry about the future of health care in the US, only because I don't see the GOP implementing anything other than the not-too distant status quo, which was broken. I sympathize with their stated ideal of reducing costs and increasing competition, but it seems like doublepeak for reducing costs and decreasing competition for established financial interests and increasing competition for everyone else. The net effect will just be squeezing more and more money out of the common individual. |