17 Comments

Mr. Klepper: I live in a semi-rural area of Colorado. All of the factors you mention are prominent in my area, plus one not mentioned, and that is the use of non-compete clauses by major health care providers. These clauses force health practitioners who wish to change jobs to move hundreds of miles from their practice regions. The use of this device puts a clear constraint on the medical "trade" and should be outlawed in a society who holds free enterprise as one of its most -- if not the most --- sacred ideals.

Expand full comment

I firmly believe that public schools, public parks, public utilities, public transportation, public health care and public medical services are important to our competitive future.

Expand full comment

Mr. Klepper's analysis I fully agree with, but his reasons for optimism, I'm skeptical. First, in terms of using the CAA, give us an outline of how to do this and how it is working. I'm on the Physicians for a National Health Plan Board of Advisors and and active student of health care policy for 20 years and have not heard of this before. 2nd, I am highly skeptical of new "value based" "high performers" hold any promise. Most of the current take over of medicine hides behind the language of value based care, which is really a failed health economics concept.

Expand full comment

Transparency in health care is an oxymoron. Good luck with that.

Expand full comment

I completely agree with the need for more transparency which could result in more competition. In addition, the US has the lowest spending of any high-income nation on family medicine, primary care and prevention. Without a shift in financial reward toward prevention and first-line care, we will continue to suffer from the lowest quality healthcare when compared to other nations.

Expand full comment

My dear friends, I'm concerned that you are advocating for a health system of capitalist competition that literally has worked nowhere in the world and takes us far from our best traditions of robust non-profit healthcare delivery and Medicare.

It will take a political movement to make the changes we need.

Expand full comment