6. How and Why They Spin: Inside Key Wheels

“God made man to go by motives, and he will not go without them, any more than a boat without steam or a balloon without gas.”

Henry Ward Beecher

While there are millions of gears in America’s healthcare machine, four types stand out as being the most important politically and economically. Indeed, from the perspective of the cost and efficiency of healthcare, no other wheels even come close. These four entities are doctors and other healthcare providers, health insurers, government, and patients.

The contents of this chapter help explain why the entire machine behaves in what might seem to be an illogical and irrational fashion. It is often difficult for the average person to understand why different ...

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