[ggm]

I'd be interested what one, single change might help. Something intangible like independently curated complete health record in some normative form on a smart card.

Or, a legalism of a "first do no harm" nature which demands once a qualified professional determines you have cover and it's just an argument about who pays between competing covers, you get no-worse-off service choices immediately until they decide which one has primacy.

Or my favourite: return to an NHS model.

[pitaj]

What do you mean "return to an NHS model"? The US never had anything of the sort.

To answer your question: Ban employers from paying for health insurance as a benefit. If individuals see directly how much it costs, that will put much more pressure on prices. And employees don't have to worry about losing their insurance if they lose their job.

Some other gradual options:

- end the AMA licensure monopoly, making doctors more plentiful lowers prices and increases quality

- reform the FDA approval process to make developing drugs and equipment cheaper

- cover preexisting conditions under Medicaid instead of forcing private insurers to

[margalabargala]

> end the AMA licensure monopoly, making doctors more plentiful lowers prices and increases quality

I see how this would lower prices, but it's not clear how this would increase quality. Naively I would suspect it would, at least initially, lower average quality.

[pitaj]

Medical professionals in general are stretched thin. They all have too many patients. More doctors each with fewer patients would lead to better quality.

[ars]

The one change I would suggest is switching to the HMO Capitation model.

The nice thing about it is that it can be done a bit at a time, you don't have to change the entire US at the same time.

No more fee for service, Doctors would go on salary, and without fee for service an entire insurance complication (making sure to pay exactly the right amount for services, no more, no less) evaporates.

The downside: You can only see Doctors inside the HMO network. A second downside is handling emergency out-of-network care (this part would get better as more of them exist, as they would sign sharing agreements with each other).

Note: The capitation part is critical, HMO without capitation is worthless.

[secabeen]

Is this the Kaiser Permanente model? I think it's a fairly good model, but they do pay pretty mid-level on Physician salary. It's not a place you can clear $500k+.

[ars]

> but they do pay pretty mid-level on Physician salary. It's not a place you can clear $500k+.

That's the goal!!

Very high doctor pay is the number 1 cause of skyrocketing medical expenses.

The model should be coupled with them opening a lower cost university and training 10 times as many medical people as we do today. Along with better supply lowering prices, it also means a Doctor could have normal working hours, so would not need the insanely high salary they need to pay for all the stuff they don't have time to do themselves.

[badpun]

> That's the goal!! Very high doctor pay is the number 1 cause of skyrocketing medical expenses.

Exactly! I can't think of any other country where doctors routinely make 15-20x minimum wage, and people become doctors predominantly to make a lot of money. In most countries, doctors make very good money, but not 15-20x minimum wage good. In Western Europe, for example, it's more of 5-8x minimum wage.

[secabeen]

This is why every attempt to reform healthcare that gets the approval and endorsement of the American Medical Association is doomed to failure. The AMA was vehemently against medicare, and they will be similarly against any reform that actually makes a meaningful downward impact on Physician compensation.

[iancmceachern]

Enforcing the current laws would be a good start.

https://www.propublica.org/article/health-insurance-denials-...

[dilyevsky]

One simple change - make it illegal to offer medical services if you’re not kaiser or similar structure