In a nation like the United States - a proud nation that managed to put a man on the moon within a decade - it is a sad state of affairs when mediocrity drives anything. This is a country that has never been known for mediocrity – until we found 17% of our GDP going into health care.

Most would agree that the US health care system provides access to some of the best technology and procedures in the world. It provides patients with some of the best clinicians in the world.

But within that construct, the system has a set of misguided incentives and profound mediocrity. Until these issues are addressed, true health care reform will never materialize.

Incentives in the current health care system are askew for both the patient and the provider. Mediocrity runs rampant right along with them.

For the patient, there is a disconnect between themselves and the cost of care. Since a third party is generally paying your bills, the patient loses the direct cost-vs-effect consumer-driven relationship. Subsequent to this, you don’t see a relationship between the money you spend and the outcome you get because, well, you don’t spend the money in the first place. For many, the employer spends it, and the patient doesn’t.

Of course, if you are one of the lucky ones that has health care insurance, you may have the belief that you have the “right” to be able to access any form of assessment or treatment that you wish. This could be something evidence-based or otherwise. If you have health care insurance, you may be convinced that you should have the right to access any and all of it, and as soon as possible, please and thank you.

If you are a provider, you are billing a third party insurance company a fee per procedure. You are paid a sum based on each procedure, whether it was the right one or not, or whether it provided a positive outcome – or not. You really don’t have to be accountable for your outcome – you will get paid either way. With that said, there is little reason to be better than the rest because, frankly, you are getting paid the same as the rest anyways.

If you are a legislator, you probably have pretty impressive health care insurance. This is probably a far cry from most of your constituents. With that said, you can now side with lobbyists’ agendas while you enjoy both the campaign contribution and your wonderful health care insurance. Now, imagine if there was an incentive to make the system better because your own health care was dependent upon it, much like the rest of your constituents. I suspect we would see a lot fewer successful lobbyist initiatives out there.

True health care reform will need to consist of removing these two significant barriers. If there is ever going to effective health care reform, then our health care dollars need to be used to pay for evidence-based practices only. Pay providers based on their use of evidence-based strategies, and give them bonuses for successful outcomes. This would eliminate over-utilization, and it would promote the idea of a provider doing a good job in order to get paid well. Now that is an incentive that we should understand well in the United States. Capitalism and a successful (and revolutionary) health care system do not have to be mutually exclusive.

Photo credits: Simon Blackley