By Dutch Rojas
Those who imagine that legislative reform will cure America’s healthcare maladies suffer from a particular form of historical amnesia.
Since Medicare’s inception in 1965, we have witnessed a parade of governmental interventions each promising to remedy the unintended consequences of its predecessors, each creating new distortions requiring subsequent correction.
The problem is not one of intention but of institutional capacity. With its complex structures and vulnerability to special interests, our governmental apparatus lacks the agility to manage a sector comprising one-fifth of the world’s largest economy.
One might as well ask a lumbering 19th-century battleship to perform the maneuvers of a modern destroyer.
Consider the sheer scale of competing interests: The pharmaceutical lobby spent $233 million in 2020 alone.
Hospital associations deploy armies of lawyers to protect their territorial acquisitions.
Insurance conglomerates have transformed regulatory compliance into a competitive advantage that strangles smaller competitors.
The tragedy is not that government officials lack good intentions as many are indeed animated by genuine concern for public welfare.
Instead, the tragedy lies in the mismatch between the tools at their disposal and the complexity of their problem.
Independent physicians, meanwhile, have no such institutional constraints. Armed with a coherent strategy and binding contracts, a coalition of medical practitioners can accomplish in months what would take the government decades.
While Washington deliberates, doctors can act. While legislators draft thousand-page bills, medical coalitions can transform care delivery with ten-page agreements.
