Guy L. Clifton, M.D. wrote an interesting book about health care in America. The important point he makes is that no matter what system we may devise, ultimately we can’t fix the current crisis without controlling costs.
Clifton’s describes from personal experience (as a neurosurgeon) how most physicians work without any clear notion of what is the most effective standard of care. For example, spinal fusion procedures which are truly effective for a narrow range of cases are used for many inappropriate – to the point of being counter-productive. (Then there are the drug companies, and others who esteem profit inordinately; who are motivated to push their wares onto harried physicians as the cure-all. They also attack consumers through advertising in a manner that used to be considered unethical if not illegal among medical professionals.)
Clifton’s contribution to the discussion is to suggest that we have a Quality Assurance organization/agency which seeks to involve physicians in developing scientifically-based standards for care. He believes that an incredible savings can result.