I've lived through the transformation of American health care. Some things are better. The advance in technology has created possibilities that are truly transformative, like stem cell therapies, less invasive surgical procedures, and better tests.

The basic system, however, is much worse.

In 1974 I lived in a village on an island in Alaska. Many folks did not have any kind of health insurance. Such benefits were a feature of careers, and most jobs didn't provide them. When you went to see a doctor how, when, and if you paid were dependent on various factors, such as the willingness of the doctor to make it possible.

As you point out, this is a strong indicator of the interest of the doctor in caring for the community. If Clem came in with a festering wound from being attacked by an enraged and jealous rooster, Dr. White could accept a couple of hens as his fee. He could turn Clem away and tell him to quit bothering the hens. He could only accept payment in cash, from an insurance company, or through nominal charity(s).

Folks chose doctors accordingly. Doctors chose to practice according to their priorities and interests. The spectrum of means of getting care tended to work out according to the plethora of options, which included wait time for MDs that would negotiate payment per patient ability.

Then Congress mandated employer provided health insurance, and doctors became less flexible in how they accepted payment as a rule. Today, most doctors work for particular insurers, and few will accept cash, chickens, or other arrangements. Most patients don't have much choice regarding who their doctor is, that being determined by what insurance they have.

Medical care costs have increased practically exponentially, while the level of care and personal attention has decreased inversely. In 1974 people would fly in from around the world to avail themselves of the best health care system in the world. Today people fly to India, Brazil, or elsewhere to escape the noxious health care system in America.

I have watched the slow transition from a diverse and voluntary system to one dominated by insurance megacorporations, and observe that the bulk of the increase in cost has been in profit to insurers, rather than better care delivered to patients, more health care professionals, or better paid doctors.

The basic mechanism that has caused costs to rise and service to decline is government mandating of medical insurance, and it is easy to see how this has decreased the freedom both patients and doctors have to choose one another, and how they pay or get paid.

America has gone from having the best health care system in the world when I was born, to being around #50 or so in child mortality - a remarkable decline.

The fix is simple: end the mandate of employers to provide medical insurance, and let the market restore nominal pricing, service, and charitable mechanisms, leaving doctors and patients free to sort such matters. This won't happen, because the #2 industry in the world, after government, is insurance. Insurance has become part of government, and insurance payments are now a form of tax.

It should happen. I want my kids to have the kind of health care system, and doctors, I enjoyed when I was a young.

Thanks!