Demonetize Medicine

Fashions come and go. Medicine despite our scientific origins engages in the same, some internal some externally imposed. Capitalization and industrialization promised a health care system where in current industrial management technologies would lower cost, increase productivity and improve outcome. Corporations, mergers, and healthcare providers compet for space at the seemingly unlimited healthcare feeding trough. The art, compassion and excellence of an Aescelapian medical profession gave way to greed to put it bluntly. Industrial medicine monetized every aspect of healthcare raising prices to the point of deminishing returns at the bottom line, unbundling and championing a new class of supper administrators with salaries in the millions. As a result, US medicine, for a time, the  world's leading profession, now ranks near the bottom of the 37 countries comprising the Organization for Economic Cooperation and Developement (OECD) and their metrics for ranking health care. We have the highest underlying cost structure, the most obscene prices and the worst outcomes, reference the Global Burden of Disease (GBD).

We are in the midst of replacing a structure who's heart was in the right place but still did not cover everyone, was a fiat progressive tax system to itself and had the effect of a blank check for procedures, Perscription drugs, hospitals and any other organization with a pretext of healthcare. Politics, burocracy and external forces rather than professional, medical and academic drive the change as well as the outcry to maintain the status quo.

Disruptive change in the form of genomics, artificial Inteligence, imminaging and hand held or bedside diagnostic tools in the hands of the primary care physician may demonetize much of the burden. However, there remains the challenge of removing layer upon layer of administrative waste, a system of corporate medicine favoring the bottom line over patient care we need a return to basic education, excellence and especially continuing medical education (CME).

If I was the Zar, I would run a public system through medical schools, state by state, open to everyone, salaries only with incentives, and run it in competition with private insurance based fee for service. We are playing catchup, so there is nothing wrong with looking at European systems that produce better outcomes at much lower cost. Demonetize the greed.