The Costs and Challenges of Reform

The scale and scope of the US healthcare ecosystem are unlike those of other manufacturers or service providers—it is by itself one of the dominant economic forces in the country. Healthcare is one of the largest contributors to GDP, and it shapes the financial dynamics of both public and private sectors. Everyone will also eventually get sick and likely be personally impacted by the healthcare system’s effectiveness or ineffectiveness, so it’s of vital interest to everyone that this system works well. However, no single group we described in this book can deliver effective healthcare alone. Multiple groups must work together, each in their specialized roles, to deliver effective care to the patient. Individually, each group must also succeed as a business, which often puts them in conflict with other groups. This simultaneous need to both cooperate and compete has led to many of the unintended consequences of previous healthcare reforms and the failure of many otherwise promising innovations. In this chapter, we discuss two examples of how well-meaning reforms intended to benefit patients led to unintended consequences.