Pardon my missing the USUHS, but it is not big enough (hence my comments about not being leveraged enough). The military should be able to generate enough MDs to cover all military hospitals, VA hospitals, and enough clinics to provide 90% of all medical services to any military dependent within 50 miles of a signficant military installation. Basically, if you get military benefits, it will be delivered by a military MD. It is one way of controlling a huge part of the cost structure. We should not be paying for a military doctor to be educated at a high cost non-military medical school.
And once they've served their time, these well-trained MDs, not encumbered by debt, will have a significant impact on the cost structure of the private sector healthcare delivery system. It won't take many years for people to figure out that massive debt for a MD just won't work any more, so the whole cost structure of medical schools will have to change.
As to the equipment cost issue brought up, my comment about the "boutique" business management of the health profession applies here. Yeah, every hospital in town wants every multi-million dollar diagnostic machine, but you'd be surprised how many private practitioners have a lot of high cost equipment in their office that gets very light use. Why? As you alluded to, the health insurance system is not engineered to optimize an industry, just pay UCR rates which are set not by the low-cost producer, but by the bulk of the producers of a service.
My comments about the "free market" criticisms (I agree that we don't have a free market), go to a lot of people who don't want government running the healthcare system (i.e. Obamacare). Let's face it, in business, you don't outsource a task that you can be as good (if not better) than your suppliers at producing. The government is committed to providing healthcare to its military and their dependents. Why outsource what you can do as good as or better and have the ability to control your costs?
And those who say the government can't do any large project better, show me any country in the world that has a private road system or a private military that works well. There are plenty of accountants who can manipulate figures to deliver small parts of the system cheaper, but the integrated whole system is not so easily replicated cheaper, especially when the government has the finances to do as the need. I'm not saying we need a single-provider system for all US citizens, as I know there is a limit to advantage of scale in any market and a diversity of providers does eliminate the complacency that can come to a single provider across an entire market. But since we do need to provide very specialized healthcare to our military and veterans, why not do it right for them and their families and contribute to the betterment of the entire healthcare market.
BTW, I agree that health insurance as a fringe benefit of employment is not a very good way to run an operation. I'm of the ilk that one should be financially liable for one's own health. I also believe that only the top 1% can afford to be uninsured in today's market and to not be insured for the rest of us presents this society with a potential huge cost which cannot be recovered, but have decided to require of our hospitals. Hence, while the red party seems to rail at infringement on individual rights, this once again isn't a place where freedom is absolute, because failure is prevented by the larger population. How we make sure people contribute (through insurance) to the solution is entirely debatable, but the tax code is as good as any. The blue party has chosen to complicate things in the creation of new entities to make sure insurance is available on a federal level - I'm not sure it needs to be there, so it isn't like I am particularly partisan on this issue.
As to creative ideas in managing costs, my employer requires us to have annual physicals and has hired an outside firm to watch our test results and steer us towards appropriate actions. A bit big-brotherish, but if they are paying the tab, they set the rules. I'm hoping they are tracking how this impacts the outcomes down the road (good science requires this), but taking the larger view of health of the population is progress. Of course, if my employer were really concerned about my health, they would institute management practices that don't contribute to my rising blood pressure...
I'm glad you will have access to the 2 billion healthcare records (quite frankly, being a data guy myself, I would have figured it to be about 100 times more than that on an annual basis) if you actually break down the line items for the services rendered. Nice data warehousing project. I'm sorry to hear that they didn't see this trainwreck coming sooner. Somehow doesn't surprise me, though.
The problem with just having your own data is that you really cannot see how your delivery system compares to the rest of the country. There is so much more we can do, but we are so deadline driven to "solve" the problem that we can only look at the simplest of parts for solutions, hence the raise the co-pays, etc. approach. Sad.
