Universal health care for the United States in the same vein as its European counterparts will never be achievable, I'm afraid. No matter what the US does to reform its health care system, it will never be as efficient as the ones found in Europe. If only because of physician compensation.
Let's say the U.S. health care system streamlines the administrative stuff and gets rid of lot of overhead, down to the level of Europe's (lmao, I know). Let's say personal malpractice is reformed. Even if they did that and now every American has health insurance and every American doctor can now treat freely without fear of being sued, it will still be more expensive than Europe's. Why?
Most American physicians are not salaried. They are based on the number of "stuff" the doctor does. "Stuff" could mean 1)number of patient visits per hour, 2)PROCEDURES, etc. kms_md's most hated letters of the English alphabet when he first started out practicing after residency were probably
D,R,G. A compensation system based this way will always produce more aggressive testing and treatment and therefore more expensive as a whole.
Salaries IMO are less ethically challenging in terms of conflict of interest from a physician's standpoint. But salaries also imply that the doctor isn't his own boss.
American physician groups enjoy far greater employment freedom compared to their European counterparts. American surgeons can band together and invest in a multimillion dollar outpatient surgery center, for example. They can be their own CEOs. They'll make far more money than being in a salaried position. They'll have to give this up if they want the healthcare system to be more efficient. They'll never give this up, because they already have racked up hundreds of thousands of dollars in medical school debt. So if you want to get to the root of this particular problem and change the young American physician's mentality that "I need to start making money fast" after residency, you'll have to subsidize the fees of these world-class American medical schools, just like in Europe. Now try convincing 170 American medical school deans to do just that. They'll laugh your face off.
Know what the scary part is? There are hundreds of thousands of American doctors who are underbilling for their services. A critical care intensivist can substantially increase a hospital's revenue by exhaustively writing down all the diagnoses on a critically ill patient in the daily record. The treatment hasn't changed. The prognosis hasn't changed. But now that "hyponatremia" has been added to the list of illnesses, the hospital can now bill the insurance company for more. It's not gaming the system (
although this also exists), but potentially showing just how much more fucked up this current system can be.
I'd love to be wrong about this and be shown that American physician groups can change and become more salaried, but I think an American entrepreneur will first invent the flying pig before I see that.
