Also the statement about doing a good job protecting people from illness is purely speculative I think. I only have anecdotal evidence from friends that are doctors treating medicare or medicaid patients, but by the time those people go to the dr., they are pretty sick.

I think government has to take the health care revolution to completion (and I support something similar to David Goldhill's plan of government-enforced/supported HSAs), but I don't think the government can do anything more than put a patch over the ugly, broken system until some entrepreneurs show the system where the path of least resistance is.

I'm a business guy (a suit, if you will), so maybe I'm not putting enough faith in government — but it would be much easier for progressive leaders to push through a comprehensive plan that had an analogous, successful private-market peer.

Finally, I didn't mean to indicate that the boutique healthcare was for all Americans, but rather that entrepreneurs should find ways to mimic the benefits of boutique medicine in a way that's affordable for all (most preferably a time-intensive free option and a time-saving affordable option).

For the time-intensive free option think a preventative version of WebMD (perhaps personalized for a nominal fee with something like 23andMe) and for the time-saving affordable option, think HelloHealth.

I think medical tort reform (h/t to @fredwilson for calling it what it is) is a fantastic idea, and I think caps could help drastically change the landscape (especially for injury lawyers, whom I think should make less as an industry in a more balanced world).

Thanks for the book reco.

One relevant perspective they have is to put a cap on how much someone can expect to get from a malpractice suit. If someone thinks they have the potential they can blame an ulcer on the doctor and expect to gain $1 Million vs $10,000 that makes a big difference. Also they suggest people have the option to opt out of the right to sue. Many rational people could choose to do that and be fine and save a lot of money, because it's built in to the costs without our ability to choose.

Malpractice Insurance only costs 1% of the medical expenses (but 30% is estimated to be due to unnecessary procedures done to protect from malpractice law. I'd love to see tort reform that streamlines the process for dealing with malpractice, caps payouts, and removes the stigma of making mistakes as a doctor. Doctors should not fret as much as they do today about ending up in court, it should be seen as an unpleasant, but normal part of the job.

Progressive personal incentives are absolutely required, preventative medicine has to play a bigger role in our health and it's got to come from more medical generalists. Some believe this means we need less specialization from doctors, I think it means we need to lower the bar for generalists. 99% of the time I need to see my doctor a well trained RN would do — we can do more for cheaper by creating a new role for more consistent, preventative care.

Not sure I agree with Medicare/Medicaid being a mess — I think it's done quite a good job of protecting people from major illness. It could be better (esp. at preventative care), but it's doing fairly well. In fact, most lower-end boutique doctors (like the one I see) also accepts medicare/medicaid patients despite no economic need to do so.