I was just reading Jim Kunstler's blog, Clusterfuck Nation. His current post gets into healthcare. He cites the work of what he characterizes as a 'clerical' administrative group of people as the prime problem in a system of healthcare denial. He further elaborates that he thinks the fear of eliminating so many jobs in that group which have middle class wages attached to them is part of the problem. I think one of the comments to his blog is telling, in that it said the way to kill cancer is to starve it. I think that is telling because I believe this whole mess started when employees were allowed to contribute to medical plans pre-tax. This allowed employers a way to offer employees higher wages, so to speak, without having to pay the employer side of employment taxes. They could contribute more to health plans and it would look like a wage increase to the employees, while not costing the employer as much as an actual wage increase would.
The thing I liked about Obamacare was that it tried for some kind of price discovery when it came to healthcare. They tried to post costs and coverages. The fault in that, of course, was that it did nothing about procedural price discovery. Nor did it glimpse into medical supply price discovery. None of the 'rackets' which suck at the teat of what has been made huge by pre-tax incentive are being called to task. Not Kunstler's administrators, and certainly not everything else that doesn't rely upon an actual market for the establishment of its price.
There are two widely divergent marketing models at stake here, that of the paperclip and the Rolls Royce. Healthcare has been using that of the Rolls Royce for some time. In Kunstler's blog he states that he believes the system could devolve into a locally based clinical type of system. He doesn't believe that is inevitable, but he offers it as a possibility. What's he's doing is seeing the efficacy of the paperclip model to provide healthcare to people. I don't know if the local clinic model is the best way to arrive at that, but I do think we need more of that. What we have now is a thing, the Rolls Royce, that seeks what the drivers, those who control what happens at the margins, have to offer. Those people have a lot more than the rest of us because the form of capitalism we believe in allows such a concentration of wealth at the top. There remains enough operation in the middle, even though many do go bankrupt, to extend the thing out to the margins. Eliminate pre-tax contributions and that middle fat might decrease just enough that Kunstler's administrators realize they have to arrange their businesses the paperclip way.
http://kunstler.com/clusterfuck-nation/racket-of-rackets/