ABSTRACT
We spend almost $10,000 per year per capita in health care, about twice as much as the average developed economy. However, we get little for what we spend: in terms of major health outcomes, such as infant mortality or life expectancy, we rank below most other developed nations. Why? This chapter explains how we have not resolved this issue yet. It also provides historical reference points, in particular describing how every developed country other than the U.S. has had universal care for decades. While Prussia’s Otto Von Bismarck implemented the first universal care system … in 1883, our health care history is a patchwork of partial reforms, an inefficient collage of private and public institutions. We first tied health insurance to employment after WWII, because business and conservative opposition would not allow universal coverage; then added Medicare in the sixties so that our seniors would have coverage after they retired; then Medicaid, a different one for each one of our fifty states; then Obamacare; and now its potential “repeal and replace.” The one common thread is that health care complexity, like entropy, keeps increasing. We have a myriad of different insurance plans and hospitals. Government entities and private companies both run health care operations. Complexity is overwhelming, and overall costs are out of control. Many of our health care providers and hospitals are close to insolvency. But not everybody is losing in our system: the for-profit health insurance sector and pharmaceutical companies do very well financially. There is profit in complexity, and this also explains resistance to change.
