Fractured Health Sector

Ezra Klein points out a problem in health care:

Awhile back, a health economist I met made the point that the very high performing systems in the US -- Mayo, Cleveland, Kaiser, the Veteran's Administration -- are all entirely integrated. Indeed, she said, the thing about them is that they actually qualify as systems. The doctors, buildings, machines, and so forth are all owned by the same institution. That, she argued, was much more important than who ran them or whether they were non-profit or socialized or academic or private. The rest of health care, she said, is a sector. When you're dealing with Kaiser or the VA, they have data from and control over every link in the chain. When it's your insurance company negotiating with an urgent care ward that sends you to a hospital who prescribes a follow-up with a private specialist who tells you to pick up a prescription at the drug store of your choice which gives you a reaction which sends you to the emergency room which then puts you in touch with yet another private specialist...well, that's rather a different story. It's just too fractured, and too few of the actors have an actual incentive to coordinate.