This is I think part of a "phase two" of a series of articles I wrote a few months ago about political economies, about corporate structures, about "hacker centric" business models. In that vein of thought, I suppose this post was inevitable.
My argument, in "phase one" was that big "corporations" were poorly constituted to develop sustainable business models, to act in the public interest, and to further the best interests of their employees and customers. I made the argument that we needed structures in corporate law (and in culture at large) to recognize "co-operative" (coops) organizations that promoted organic self-organization, and more nimble institutions that could participate in "authentic economic exchange."
I've been having a lot of conversations in the past few weeks that have revolved around the current progress of the health-care "reform" process in America, and I find that I keep coming to the same conclusion:
The rising costs of health care in the United States, is largely due to the overhead imposed by the insurance industry. Both in the increased bureaucracy that service providers have to endure (so service providers raise their fees to cover this cost,) and secondly in the form of the insurance companies' own profit margin.
As a result, I've become convinced that the problem with rising health care costs is the insurance companies themselves and that any scheme that sees legitimacy in attempting to address "the health care problem" by taking the interests of the insurance companies as being integral to the solution, rather than the root of the problem has already failed to address the problem at hand.
What I've been saying, is we need to work backwards through this problem. The prevailing logic seems to be to figure out how much procedures cost, how much we as "clients" need to pay, and how much our employer/the government can afford based on those projections, and then how much we have to pony up to cover the gap. I think it makes much more sense to figure out how much people (doctors, nurses, technicians, clinical providers, etc.) need, how much supplies cost (lab work, supplies, chemicals, physical plant things,) include some fringe expenses (e.g. educational expenses, preventative outlay, technological infrastructure), and then figure out how to pay for these costs: co-pays, tax funding, health care trusts. That's at least a viable solution.
With the base expenses taken care of, providers are more free to organize in complementary groups, in co-operatives that provide various kinds of general purpose and centralized services. Alliances can be formed to distribute clerical and management responsibility, on smaller scales. Makes sense.
Good luck in seeing that happen.