Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What does American healthcare want?

Janice Boughton, MD
Policy
May 13, 2013
Share
Tweet
Share

I know what I want in healthcare. I want it to be efficient, effective, thoughtful and inexpensive. I want it to create healthy people who don’t need very much health care. I want it to involve elegant solutions to problems that take less time, money and effort. I want it to be so much easier and less expensive that taking care of all of our people uses even less resources than taking care of only some of them, as we do now.

But the healthcare industry in America is bigger than me, and bigger than all of the doctors who work in it, even if we could all agree on what we want. So what does it want?

Is it even reasonable to think about healthcare as an entity? I propose that it is, that this way of looking at it makes the direction it has taken much more understandable.

We observe that bureaucracies grow, even though we complain about how they should shrink and become more efficient. Agencies beget more agencies, and attempts to reduce bureaucracies often don’t work. I’ve seen what happens at our local university when educational budget cuts happen. They cut positions, but the people who remain are expected to pick up the functions of the ones who lost their jobs, which leaves the scope of the bureaucracy the same size as before, but temporarily overworks the people who remain (until they hire new people to unload them.)

The healthcare delivery system in the US has progressively grown, primarily driven by the growth of insurance, both government and privately funded. This has brought financial professionals heavily into the delivery of care, and has also increased the amount of money available for services. The availability of financial resources makes it more  possible to continue to treat patients who become sicker and more dependent upon it. It is also more feasible to develop very expensive technological approaches to illness, which expands the system to include scientists, device manufacturers and the companies with their own workers and advertising professionals. This just gets bigger geometrically.

Even if individuals within this vastly complex system want care to be cheaper and less complex and patients to be less dependent, the system itself does not want this, and continues to grow. It’s hard not to invoke the metaphor of a large, stupid and perpetually hungry giant. Even without the metaphor, mathematics explains why complex, inefficient technological medicine that creates dependency wins out over elegant, efficient and cost effective medicine. The complex and inefficient version is bigger. By its nature it is bigger, which, in the absence of an external force deterring it in some way, or some catastrophic imploding event, means it will continue to be the bulk of what healthcare is.

So why even try to find the elegant solutions? There is abundant talk of implosion and the affordable care act has made some attempts to externally deter the growth of the healthcare industry. I don’t see the former as happening anytime soon and the latter seems unlikely to have a major impact, but if we keep looking for ways to make healthcare be less expensive and more of what we, as patients, really want, those solutions will be available when we really need them.

Janice Boughton is a physician who blogs at Why is American health care so expensive?

Prev

How to effectively follow a patient’s multiple medical problems

May 13, 2013 Kevin 7
…
Next

It’s not hard to do surgery, it's hard to get to do surgery

May 13, 2013 Kevin 1
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
How to effectively follow a patient’s multiple medical problems
Next Post >
It’s not hard to do surgery, it's hard to get to do surgery

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Janice Boughton, MD

  • Why physicians should start thinking about climate change

    Janice Boughton, MD
  • An experiment in removing the heart from medicine

    Janice Boughton, MD
  • The politics and commercialization of fecal transplants

    Janice Boughton, MD

More in Policy

  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • Most Popular

  • Past Week

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Essential questions about nurse practitioner liability insurance [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
    • 9 domains that will define the future of medical education

      Harvey Castro, MD, MBA | Tech
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • What led me from nurse practitioner to medical school

      Sarah White, APRN | Education
    • Why local cardiac CT scans could save your life

      Benjamin Cohen, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Essential questions about nurse practitioner liability insurance [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
    • 9 domains that will define the future of medical education

      Harvey Castro, MD, MBA | Tech
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • What led me from nurse practitioner to medical school

      Sarah White, APRN | Education
    • Why local cardiac CT scans could save your life

      Benjamin Cohen, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What does American healthcare want?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...