It seems everyone working in the health insurance and health care industries feels entitled to large profits. And they will do or not do just about anything to get their share of the multi-trillion dollar a year health care "market." Doctors thumb their noses at "low" Medicare and Medicaid payments, limiting the number of patients in these programs that they will treat. Health insurers balk at insuring the very sick without government subsidies to reduce their financial risk. Pharmaceutical companies threaten to curb drug innovation unless they are allowed to impose astronomical markups on existing products and enjoy long patent periods. And hospitals do whatever the heck they want to make a buck--different prices for the same care with no transparency or explanation. And these are only four of the big players in the health care market; there are many others elbowing for their share.

Under these conditions, American health care reform that tries to lower costs is dead on arrival. The powerful groups benefitting from our overpriced health care system aren't going to accept a pay cut. Some may suggest incentives to get doctors to accept lower reimbursements, like subsidizing their student debt or even reducing the requirements and the number of years it takes to become a doctor. Others may suggest performance bonuses, like the ACA tried.

There are a lot of good sounding suggestions for lowering health care costs, including drug re-importation, universal use of electronic health records, value-based health care pricing, hospital consolidation, competitive bidding for supplies, focus on tertiary care, etc. You name a health care cost cutting idea, and great minds have already penned it.

One health care cost cutting idea receiving more attention is allowing future American doctors to enroll directly into medical school instead of first getting a 4-year undergraduate degree. Medical students and the country would save a lot of money, and their student loan excuse to demand high salaries falls away. Many countries with similar or better health care outcomes require 5-6 years of schooling to become a doctor versus 8 in the U.S. But American doctors won't easily give up the prestige of being a doctor and, therefore, will continue to demand higher salaries.

Reforming payments to doctors is just part of the problem, and they are not even the biggest drivers of health care costs, hospitals are. But if we can lower doctor fees, the other players will take notice and realize they are next. Ideally, they will take steps to lower costs before forced to do so.

So, how do we lower doctors' fees? By hiring foreign trained doctors. Our next step in health care reform should be to have a publicly run system of care for everyone, and we should hire foreign trained doctors to provide the care. This is not an unusual practice around the world. The U.K’s National Health Services hires thousands of foreign trained doctors a year to address staff shortages, and Cuba’s economy greatly relies on the financial payments from exporting its doctors wherever needed. American doctors can continue to work in the private health care market treating individuals that prefer the status quo.

Conclusion

The Affordable Care Act (aka Obamacare) received criticism for keeping the basic structure of how Americans access and pay for health care. But truthfully, it was never a fair fight. Confronting powerful, well-funded and organized groups like health insurers, pharmaceutical companies, device makers and doctors is not a winnable endeavor. We should keep the health care system we have and create a parallel one with different players that covers everyone.

Tags: Medicare For All, obamacare, Affordable Care Act