US heathcare "system"

The US healthcare "system," and reform thereof, almost defies characterization, except perhaps as an elusive moving target. It is immensely complicated, almost inexplicable, costly beyond belief, seriously discriminatory, and often unsafe. It is responsive, if at all, to multiple regionally and demographically varied forces. These include patients, healthcare providers (physicians), insurers, and the various controllers of these players, such as the federal and state governments, professional associations, industry, and academia -- especially the education and research enterprises. Myriad groups function as connectors at interfaces, such as communications and computer companies, and as scavengers at the fringes, such as liability attorneys. One overriding element is crystal-clear. The money expended from all sources in American healthcare is extraordinarily large, some $1.7 trillion in 2004, one seventh of the total US economy, and larger than the total economies of most countries of the world. This cost is in excess of that of any other country, when measured in total, as a percentage of the gross domestic product (GDP), per capita, or by outcomes. Worse yet, even though awash in money spent, over 45,000,000 Americans are without health insurance.

Who is in charge of the US healthcare system? No one and everyone. Anarchy and chaos stand side by side. There is nothing remotely akin to a "US healthcare czar." "The marketplace" determines how much money is spent on what and how many people of what types work in healthcare. Yet, it is by no means a "free market." It is constantly reshaped by numerous forces, none truly predominant, although government of all kinds, including Medicare, Medicaid, the Veterans Administration, the Public Health Service, and the 50 states and many local health departments -- plus the military, government in aggregate constituting nearly 50% of all US healthcare expenditures. Who can "order" that patient safety measures be put into effect? No one. Who can require compatible computerized medical records in the home, the doctor's office, the pharmacy, the emergency room, and the hospital? No one can, even if such an implementation would provably save lives and money. Who can ensure that the quality of care provided in the physician's office, where the most care is given, is above a certain standard? No one. Who can even require that it be measured? No one can. You may ask why we spend so much and get so little. Actually, we get a lot, not a little, of testing, technology, medications, surgeries, hospitalizations, and all the rest -- often a lot of what we need...only a little.