Today the cost of healthcare in the US is higher than in any other western country, while the delivery of this healthcare is limited to only those that can afford it (or are old or very broken).
There is clearly no perfect model for healthcare, because there is not an infinite amount of doctors, pharmacists, scientists and support personnel available to deliver it, and of course there is a limited amount of money available to pay the people that are delivering health-related services.
So there is a choice that always has to be made to balance the use of resources against the need.
In the US today the choice that has been made is to charge each individual directly for the health services they consume, effectively meaning that those who are richest get most health care.
In other countries the choice has been made to deliver the available health services as broadly as possible, so as to maintain the health of whole nations.
Both models have pro’s and con’s.
The US system means that the wealthiest people will most likely live longer. Since wealth is (often) a consequence of many attributes that do progress all of society, there is a case to be made that keeping the richest alive longest is Darwinian in nature.
Conversely distributing the available health resources amongst the whole population should increase lifelong productivity for the largest possible number of the population. When more experienced people are able to work longer this should provide a great return on investment.
What is clear though is that there is a limited resource, which is outstripped by demand, and so choices will always have to be made.
When a limited resource is made to be as efficient as possible, by rigorously implementing best practices it can be made to go further.
The US model today is one where health providers generally get paid per-service delivered, as opposed to health outcomes.
In business it can be seen that outcome based remuneration is always preferential to activity based remuneration. If you pay a bricklayer for each wall built, you will get a lot of walls built, but the quality may suffer. While if you pay that same brick layer for each brick laid, you will get a very different outcome (very thick walls). But if you measure both the quality of the wall built as well as the number of walls built, that same bricklayer will really think about how to built the most efficient and effective set of walls.
In business if you paid someone for effort and not results, you would see huge inefficiency. Today that is exactly how healthcare works in the US.
Health insurance companies can offer some economies of scale, and the bigger a network is, then the larger the economies of scale.
Now add to this model outcome based charging and the whole model will be about keeping everyone who is insured as healthy as possible.
And then add it some balances to ensure that sick people are not just dumped from the program to keep costs down and you have a basic working health system.
What is eminently clear though is that the more people in a network, the better the overall efficiency can become.
So why not have everyone is a single healthcare system?
Well the only argument against this is that simply what is the motivation for that healthcare system to get better. But that is an issue that over time can be fixed by clearly defining the reward system for those who work in the healthcare system. We are not there yet, any it will take a lot of smart people a long time to work this out.
Healthcare is expensive, limited and emotive, there is no perfect system anywhere in the world. But that does not mean we should stop trying to be the best we can be.