I sometimes joke that if we brought together the country’s most talented
health care experts and asked them to design a system that gives as little
value for money as possible they would have trouble coming up with something
better than what we currently have. Of course, the situation we find
ourselves in isn’t a joke. Through no planned design or evil intent, our health
care system has evolved in ways that better serve a myriad of economic, professional,
and political interests than those of patients and families, and the
larger public. Money has always had a place in the provision of medical care.
But “big money” has become dominant, and the forces it has unleashed in the
quest for profits have had perverse effects. There are many talented and dedicated
people working to provide high-quality health care, but the culture of
American medicine and the force of prevailing incentives do not play to their
goodness.