There is a great outline of the history of the US Healthcare System starting with the 1900s from PBS. I've been involved operationally with the evolution of our healthcare system since the late 1970s and really think we can't talk about reform until we have looked at where we have come from. I've recommended the book Social Transformation of Medicine, but if you want a short overview at least look at the PBS timeline at https://www.pbs.org/healthcarecrisis/history.htm.
I think it is important to remind everyone that health insurance started with GM offering this as a benefit to attract employees in the 1920s. Before that time, people paid cash, pigs, eggs, chickens, etc. as compensation for their healthcare services or received it for free from those with a calling.
The US and sophistication of medical care and interventions grew and these efforts, like many others that followed were soon outgrown. Finally, the government took some decisive action in 1965 with the Medicare and Medicaid legislation. Since that time, we have continually worked to refined the way our healthcare is delivered and the mechanisms for covering the cost. Once again, we find ourselves in the position of needing to improve the system and its processes and we have two choices.
a. Continue to build upon the creative ideas that have made the quality and safety of our healthcare second to none.
b. Tear down the system that has been built by employers, taxpayers, healthcare industry and multi-government guidance and investment by slowly allowing our legislators (the people late to the party) to move toward a single payor system that will create a monopoly and devastate our ability to make choices.
I recommend that we not throw out the good work of so many and that we find new and creative ways to address the current gaps -- the uninsured. To be successful, we must address each of the environmental impacts upon the healthcare system and these include:
over regulation (healthcare is the most overly regulated industry in the US)
public education and understanding of the societal issues that impact the cost of healthcare (immigration, end-of-life care, lifestyle choices, etc.)
promoting individual self-responsibility, self-control and investment in making choices to help reduce the costs of healthcare
tort reform (to reduce unnecessary costs driven by fears of lawsuits)
collaboration and transparency to ensure an effective and efficient healthcare system
As a society we need to reprioritize the issues facing us and move forward in the process to improve and refine the healthcare system in the US. I've been invited to join a panel of local physicians this evening to discuss healthcare reform and hope my local readers will attend so we can communicate and collaborate to identify solutions. Let's get back to applying scientific methods to improve the healthcare system, not any one stakeholder's individual interests or politics.
Think Plan-Do-Check-Act, Shewhart Cycle, or PDCA!