Basically it followed this pattern:

- you start with the premise that doctors are bad/greedy and that are incentivized to do unnecessary testing/procedures to benefit financially
- you also start with the premise that with that greed and individuality that that leads to poorer outcomes as well as poor behavior
- hospital lobby steps in and says we will get the physicians under control, weed out the bad players and offer the same services with better quality but to do so we need higher reimbursement to cover all of our commitments
- govt restricts any physician ownership in hospitals
- govt then continues to cut reimbursement while increasing regulations making it very difficult to thrive in private practice
- hospitals then go on a buying spree to consolidate all physicians under their umbrella
- with the monopoly, hospitals eventually start increasing prices.
- govt comes in and tries changing reimbursement models to "value-based care" trying to pay out based on quality metrics and not volume (in a very simplified form), but nothing really changes
- insurance now sees that they're losing more and more profit to hospitals
- insurance companies go on their physician buying spree trying to buy up as many practices as possible so that they can deliver care at a lower cost (not to the patient, but to themselves)

So now you have a battle of who controls the payment and delivery of healthcare between insurance and hospitals.

Hospitals create their own insurance (select med). Insurance creates their own hospitals/physician services (optum with UHC).. These entities are battling it out.

Then over the last 5 years, private equity says hey, I want in on this.. So they become a player to try and get their cut.

Now it's hospitals vs. insurance vs. private equity to see who can gobble up as much of the healthcare pie as possible with who's lobby can cause the most destruction due to an inept and corrupt politicians (medicare advantage, for example).

Patients are screwed. Physicians lose all autonomy and start losing their minds as they become pawns in this ridiculous game.

And there's no end in sight.. It's only going to get worse until the govt opens up the ability for physicians to run their own practice, clinics, and hospitals (imo) with true price transparency and other means to lessen the power of insurance (none of that will happen).

I think what you'll see is that you'll basically start paying for more cash-based services only (direct care, concierge, surgery center, etc) with creation of a two-tier system... though the govt will likely find a way to stop that... and those cash services are just to get decent care as you'll still be paying through the roof on your insurance (which will act more of very expensive catastrophic coverage).