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The US healthcare system seems headed for bankruptcy because of its ever increasing and unsustainable costs. These costs will be effectively controlled only by legislative reforms in the insurance and payment for medical care, but the prospects of such legislation will depend on a more favourable political climate and stronger public support. However, legislation will accomplish little unless the organisation of medical services also changes. The recent movement of US physicians into large multispecialty groups suggests that this reorganisation of medical care may already be under way. If this trend continues, it could not only facilitate the enactment of legislation, but also help to make our medical care much more affordable and efficient.
At present, most US physicians are in solo practice or belong to small, single specialty partnerships, but new social and economic forces are beginning to make employment in large multispecialty groups a more attractive option. About a quarter of all US practitioners are now employed in such groups, which are being formed by independent physician organisations and by hospitals. If their number continues to increase and if they eventually represent the great majority of practising physicians, a wave of legislative reforms could be initiated that transforms our currently dysfunctional healthcare system. But before I say more about this move towards group practice and how it might improve prospects for reform, readers need to understand how and why our health system has been failing. I should also describe the extensive health legislation enacted by the Democrats in 2010, and explain how it falls short of providing the kind of major reforms that would be required to rescue our healthcare system.
The US system is a confusing hodgepodge that makes no sense to informed observers. Although it is by far the most expensive in the world, it now leaves about 50 million of its citizens totally without coverage and fails to provide adequate protection for millions more. Most people also have no support for the cost of long term or rehabilitative care. And, despite huge expenditures, the quality of care is highly variable-but on average inferior to many advanced countries that spend much less. The best physicians and hospitals and the best care available in the US are among the finest to be found...