[supertrope]

It's not so much a choice that we take pride in doing but a problem we have boxed ourselves into. Path dependency sucks. The benefit of a republic is that huge political shifts happen over a long period of time. Sharp changes only happen in response to an immediate crisis. Normally the system rewards grafting yet another patch onto the existing system instead of throwing it out and setting an entirely new set of rules.

Medical services became much more effective when physicians accepted scientific methods. Allopathic physicians used state licensing to restrict who could call themselves a physician. Due to post WWII price controls employers offered health insurance. Baby boomers did not grow up with the existence of all the drugs we have or neonatal intensive care units. People are still considered alive after their heart stops beating. Standards of care went up. Health workers' scopes of practice are carefully circumscribed by their license which does not transfer across state lines. The government agreed to pay for the medical costs of the elderly and poor, letting private health insurance skim profits from the lower cost working age population. Attempts to rationalize the system via a National Health Service, single payer financing, or heavy regulations on a universal private insurance market have failed. Instead the ACA just plugged the most egregious pitfalls for Americans and tinkered around the edges to try get everyone insured. Some states have chosen to not expand Medicaid to the detriment of their indigent population and rural hospitals.

If medical costs are to ever stop growing at 6% per annum the end result will likely be due to a combination of price controls, wait times and limits on care to hold down demand, lower health worker pay, free training for health workers, and rationalization of the system to incentivize population wide health. Switching from fee for service to per capita removes the incentive to treat more to generate more revenue. If universal eligibility is achieved that removes the incentive to refuse service to uninsured patients or discharge them ASAP. When outcomes are measured for the health sector as a whole, problems like hospital re-admissions or high co-pays that result in some patients not filling their medication orders get a harder look instead of being a perverse gain for one business and a bigger cost for the rest of us. Right now healthcare is run as a business. Each firm optimizes for the profitability of their link in the chain. The government tries to help those left behind by loading money into the top of the medical-industrial complex without ever making changes to the Rube Goldberg machine within.