Tyler Cowen recommends George Halverson's book Health Care Reform Now!
It's a good recommendation. Halverson is CEO of Kaiser Permanente, which is one of the higher performing, better organized, health care systems around, and so he's got a pretty good vantage point on the problem. And the thing about Kaiser is that it's almost fully integrated. It owns its facilities, salaries its doctors, builds infrastructure that connects clinics to urgent care wards to hospitals, and has constructed the largest private electronic medical records system in the world. Awhile back, a health economist I met made the point that the very high performing systems in the US -- Mayo, Cleveland, Kaiser, the Veteran's Administration -- are all entirely integrated. Indeed, she said, the thing about them is that they actually qualify as systems. The doctors, buildings, machines, and so forth are all owned by the same institution. That, she argued, was much more important than who ran them or whether they were non-profit or socialized or academic or private. The rest of health care, she said, is a sector. When you're dealing with Kaiser or the VA, they have data from and control over every link in the chain. When it's your insurance company negotiating with an urgent care ward that sends you to a hospital who prescribes a follow-up with a private specialist who tells you to pick up a prescription at the drug store of your choice which gives you a reaction which sends you to the emergency room which then puts you in touch with yet another private specialist...well, that's rather a different story. It's just too fractured, and too few of the actors have an actual incentive to coordinate.
