Introduction

Abstract

Healthcare delivery systems and health insurance are in a state of crisis in the United States (Wendel, Serrett, & O’Donohue, 2018). This has been true for several decades and, as the controversies surrounding the Affordable Care Act make obvious, solutions are not easily forthcoming. Most healthcare professionals and patients are not satisfied with the quality of current healthcare. Many individuals do not have acceptable access to healthcare, with large differences in access contributing to health disparities that center around socioeconomic status, race, and geography. The healthcare delivery system is both inefficient and costly, with current healthcare costs accounting for approximately 19% of gross domestic product (GDP), a GDP amount nearly four times that observed in 1960. Advances in medical technology are considered one of the most important drivers of escalating healthcare costs (Wendel et al., 2018). Historically, as one aged, there was little one could do about joint deterioration. Now there are multiple options for managing joint deterioration such as hip replacement, knee replacement, and shoulder replacement. The aging United States population and the advances in medical technology ensure that future growth in healthcare costs will be unsustainable. Using the classic “guns versus butter” model of macroeconomics, one can confidently predict that current expenditures in the healthcare sector will reduce spending across other vital economic sectors. There are any number of other problems that can be identified as contributing to the inefficiency and costliness of healthcare. There are problems with the extent to which evidence-based treatments are being used. There is the problem of medical errors—errors that occur at such frequency that one healthcare economist has concluded that it is safer to mountain climb than to spend time in a hospital (Wendel et al., 2018). There are questions about the financial model (e.g., for profit versus nonprofit, one payor versus multiple payors, and federally-controlled versus state-controlled) that, when applied, would best ensure that healthcare systems are fiscally sound. There are basic questions about why the healthcare system is divided and even siloed between physical health and mental health. Finally, there are critiques that suggest our healthcare delivery system needs to be reoriented into a wellness system instead of a system that simply reacts to illness.