Imagine if Amazon was only paid when a product was returned because it didn’t satisfy the customer’s needs. Crazy, isn’t it. 

Now apply that same logic to secondary medical care in the USA.  Providers are paid by three groups: the government, insurers and patients.  They have a common interest: good health.  Yet these same three groups mostly pay out if the providers fail to deliver good health.  Crazy, isn’t it.

This situation is well known to all who think about the Private versus Universal healthcare systems.  But long-term situations need a good analogy like Amazon to make contradictions more apparent. 

This is not going away soon.  So, I hear you say,  thanks for the analogy but how do we save health care in the USA? 

This internal contradiction between wanting good health but being paid for failure makes providers too complex to manage. 

It creates internal chaos and divisions between management (where’s the money?) and the two kinds of staff (some keeping patients healthy, and those who fix things if the first group fails).  Providers have no serious incentive to pay attention to the common interests of their three payers if those same groups only pay them when they fail.  (Remember the Amazon anology.)

Solution: Almost all companies have found that managing disparate activities in the same organization is inefficient – hence outsourcing.  For healthcare, we need new and separate providers who deliver good health, and then allow most current providers to only fix patients – making them healthy again.

The same applies to the three payers, who should reward both types of providers based on their skill sets and goals.  No more of “we want you to make people healthy but we’ll only pay you if you fail.” 

Crazy, isn’t it.