[hippich]

Note that you never mentioned person who actually receives service. IMHO problem is exactly that - none of players you mentioned truly interested in long term cost control. Some might just care about short term budgets, but otherwise all of them will pass it down to the consumer. And consumer being on their own, with little to no competition and information asymmetry has very little leverage..

[aaavl2821]

I agree. The current players in the healthcare system view people as numbers, and that is terrible. Doctors are the most natural patient advocates, but unfortunately physicians' ability to influence healthcare, on a system or patient level, has decreased significantly in recent years.

I would love to see (and am hoping to build) solutions that give more power back to doctors and patients, and focus on patient experience and outcomes.

I know that a lot of consumers want to take their health decisions into their own hands, and I support that, but i think most people want help from an informed professional who is on their side (ie not controlled by a hospital or insurance company with competing interests)

[lotsofpulp]

Allocating healthcare resources is numbers, and there is nothing wrong with that. If you want to decrease costs, then increase the supply of healthcare. Healthcare = doctors + medicines + equipment, so all you need to do is increase that supply. However, you’ll find that the doctors don’t want to increase their supply and they’re very effective. Drug manufacturers also don’t want to increase supply, and they’re also very effective.

[aaavl2821]

I'm an Econ major so am totally on board with being analytical about allocating resources, but it's not quite as simple as just increasing supply

Healthcare services (doctor salaries + facility overhead) is 80%+ of US healthcare spend. At first glance increasing supply of doctors seems reasonable. But how do you do that? Number of doctors (esp primary care and mental health) has been declining because of decreasing reimbursement / payment and increasing burnout. Being a doctor requires a decade or more of making no money, working long and unpredictable hours, and tremendous stress -- literally making life and death decisions. Can't just spin up supply overnight. To really increase supply you'd need to increase doctor salaries or decrease the cost of becoming a doctor. The former would not reduce costs, and the latter also is not ideal

One perhaps better way to increase supply is by rolling back consolidation. So same # of docs, but more independent practices. Another way is letting nurses / others practice at the top of their licenses, although I'll grant your point that physician societies sometimes make this hard. Also, one could argue that having more work done by low cost providers would encourage more volume and potentially unnecessary care

The main overarching issue though, even if it was as simple as increasing supply, the healthcare system in the US is not designed to optimize cost efficient care. It is designed to maximize profit and regulations arent optimized around this. So when hospitals view patients as numbers, the implication is that they will milk every last dollar out of a patient (30% of healthcare spend is unnecessary care). Insurance companies are incentivized to deny as much care as possible. No organization with any power in the system is incentivized to view and manage healthcare costs in an optimally cost efficient way