Must-Read: Richard Mayhew: The Nitty Gritty of Cost Control: “This is not sexy, this is not lucrative…

…this is not the way political programs are built as the slogan ‘Minor administrative changes to marginally increase competition by redefining scope of service delivery laws when do we want them —NOW’ does not fit on a bumper sticker. However these are the types of gains that need to be made to reduce the guild power of high end medical providers. Most of the people, most of the time, don’t need high end care.  Their basic needs can be met by trained individuals who are not over-trained…. Basic dental services, basic primary care services, basic preventative services can often be performed perfectly adequately at the master or bachelor level clinician level instead of a doctorate level clinician level.  Those rules are overwhelmingly determined at the state level, so that is where the long slow slog of reform needs to come.