A top down approach to fixing healthcare simply won’t work because of the time it takes to radically alter 1/5th of our economy and the stark difference between Republican and Democratic healthcare agendas given the historical every 8 year switch between the two parties.
Under 8 years of Bush, he did absolutely nothing signficant to even attempt to change healthcare, besides hand more money to Big Pharma via Medicare. Say Obama doesn’t get re-elected, his agenda will die after 4 years under a republican leader. Say Obama does get re-elected and he has another 7 years to duke it out for watered-down reform, is that enough time to truly change 1/5th of our economy? In 7 years, it’s highly likely we’ll have another republican leader given the cyclical nature of our politics. What will Republicans do in 7 years to dismantle everything Obama fought so hard to do? You know they will. They can’t even agree on anything today.
My prediction is that if any sort of reforms happen, in 7 years, that’s when the shit is going to hit the fan, just like the shit is hitting the fan in Massachusetts just a few years in to “reform.” And that’s the best time for Republicans to dismantle things suggesting to the American people that they will clean up the insanely expensive mess Obama put us in.
Health reform will only be successful if we change the incentives for delivering healthcare. If the industry continues to get paid for how much they can possibly deliver to sick people, costs will continue to skyrocket and “reform” will fail. We desperately need this concept to be disrupted with a new business model that starts paying healthcare deliverers for doing the right things, not the most things.
The only hope I have for fixing healthcare is disruptive innovation. Ideally, this would be paid for by the federal government in micromarkets in y-combinator like fashion, but they’d rather spend $80 billion in R&D for better ways to kill people, than $80 billion in better ways to improve the health of our nation. Granted, the NIH spends $30 billion on things like cancer research. I say suspend laboratory science research and spend 80% of that money on novel ways to deliver cost-effective healthcare to populations of people. Instead, every healthcare startup faces an uphill battle against regulation and established players trying to retain their profits. And the government looks away.