To reduce healthcare costs and improve service healthcare must be Treated as a Utility. Trying to jam it into the "free market" paradigm guarantees market failure for those pieces of healthcare delivery that can be Treated as a market. And guarantees poor quality of life & death for the rest.
Picking up the Pieces from the Confidence Men
We let Confidence men con us into corrupting the very concept of utility so it went from being a source of steady & boring profits to endless opportunity for gambling, rent and generating personal riches. Thus passenger railroads, telegraphs and other utilities have been privatized and some abandoned as too boring after being thoroughly looted.
We've let privateers loose on health care with similar results.
A Better Model
Utilities involve service and goods. To deliver their service they require investment. To maintain that service they require continual reinvestment. The term for that is "sustainment." The purpose for charges, money raising & taxes is to pay for the labor of those who provide health services and the material and tools, investment, that sustains the product.
The term for that investment is "capital", which I called "actual capital" to differentiate it from the many counterfeits that get lumped under the term. Investing in actual capital & labor pays dividends in public good. The other things called capital are notations in a spreadsheet of debts and claims to ownership. They are useless without the real thing.
Hospitals, Clinics, Medical Equipment
If we want affordable healthcare we need sufficient medical equipment for our needs. Not only the ordinary ones but the needs of emergency care, disasters, epidemics and war.
In a true free market that need could be met by private actors seeking to maximize profit. But that fails with utilities. Actuarial & statistical/epidemiological methods can be used to forecast the need for medical capital and personnel. Distributing equipment and personnel & supplies well is necessary for success.
The health service is both necessary for delivering healthcare and a means for training and staffing medical personnel where needed in underserved areas or the military. We should not be importing medical personnel but training them domestically and they should exchange service for their education and training. This system would save money and also allow us to staff rural and urban hospitals & clinics alive.
Nationalize Failing Hospitals
We need to ensure that clinics and hospitals are available within each census and geographical area in the country. The simple expedient of paying doctors a salary, having enough of them available where they are needed & getting control of the profiteering of drug companies & equipment suppliers. People should be paid well for their work. But labor should not be a lottery. Rural hospitals are needed. They should not have to make a profit to continue. We currently use Medicaid and Medicare to subsidize them with soft subsidies.
Sustainable NOT PROFITEERING
We have built utilities using a privateering model. The results have been dystopic. Privateers are grifters. Privateers are pirates. They come in loot, build, make promises. They extract maximum quick returns. Borrow money on the credit of a company and pay themselves. And then get out before the system collapses. Systems have to be built on a sustainable basis. All utilities must maintain themselves for safety, security and long term function. Since most of our modern inventions are in these fields such as communications, transportation and health; the system has to build in resources for research, investment in training and education as well as modernization and upgrade in the capital.
The alternative, because healthcare is so easily turned into monopoly enterprise, is a system that charges more than its members can bear and periodically collapses.