Q: If Health system reform is not about getting ‘coverage’ for more people then what should it be about?
A: Real health system reform will improve health system quality and efficiency.
Poor quality in American hospitals, clinics, and other institutions occurs when health care is rendered that is clinically inappropriate (i.e., unnecessary surgeries or defensive medicine), or when patients are injured during the process of care (untended patients fall, bed sores, wrong-sided surgery, etc), or when a clinically proven intervention does not routinely happen (an aspirin tablet for the patient with chest pain in the ER).
These failures are all too common and lead to hundreds of thousands of excess deaths and hundreds of billions of water dollars. The financial inefficiencies of the health insurance business model are well documented and also lead to hundreds of billions of waste each year. Taken together, deficiencies of quality and efficiency in American health care business as usual leads to a loss of about 1 trillion dollars per year. That is the target of real health system reform.