Friday, March 04, 2011

The problem with US health care, education, law enforcement and much else is the system not the spending

The US spends more per capital on health care, education, law enforcement and much else, both in actual $s and as a % of GDP than any other Western country, for poorer results than most. Yet, this is rarely questioned. All too often the solution is to spend more money (this probably also applies to military spending too). The issue in most cases is that the entire structure is not viewed as a single system whose interests are aligned with the patient, the student, the person who is supposed to benefit from all the spending. In health care, the doctor, the hospital, the laboratory, the insurance company, the billing company, each only focuses on their own interests. As a result, even it each becomes more efficient, it is as though each of the car component manufacturers are designing the best component without reference to the design of the whole car. The best tires in the world are useless if they do not fit onto the car. However, someone will make money providing adapters to make the tire fit on the car. Now, there is little incentive for each participant to change their actions to benefit the whole, and thereby the patient. As has been said, one person's waste is another's way of making a living. The fact that each primary care physician requires 4 people for administration is of no concern to the insurance company or hospital. Nor are the inefficiencies of the laboratory or equipment manufacturer of concern to the doctor.

The same kind of issues impact so many services in the US. In order to repair this the entire system has to be addressed, and in a way which focuses on the person for whose benefit the spending takes place. Much as Walmart sees the entire supply chain so that it can provide the best product for the lowest cost to the shopper, we have to view the health care, education, law enforcement, transportation, defence and other services to citizens in much the same way.

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