The AMA is one of the four pigs at the trough of US healthcare:
1) Insurance companies - extract profit from the usual insurance model applied to healthcare.
2) Drug/Device companies - extract maximum profit from patent monopolies, FDA regulatory capture, and marketing.
3) Malpractice lawyers - use regressive law precedent to maximize individual payout and lawyer billing to the detriment of everyone else
4) AMA/Providers - restrict supply, and maximize billing for services
Really, none of these pigs have the interests of overall public health in mind:
- Insurance companies are incentivized to maximize the cost of insurance and deny coverage as much as possible, like any insurance company vertical. Obviously this results in denial of care. However, an insurance company is motivated to reduce provider costs and possibly to incentivize preventative care. Insurance companies are also vertically integrating into owning provider facilities to solidify local monopolies (so people HAVE to use their insurance if they live in an area) and to be able to impose cost cuts to actual providers.
- Drug/Device companies are incentivized to maximize the profits from 20 years of provided patent monopolies, often exploiting desperate people looking for relief from maladies, but the cost is usually beyond the ability of individuals to afford. Lawyers are incentivized to bill/get percentages of settlements and maximize awards of "damages" regardless of the overall impact to health services costs and the implicit denial of care that involves. However, these orgs, while generally not doing the core science of new treatment modalities (universities do that), they do help usher treatments through safety review.
- Trial lawyers are incentivized to maximize their patient damages and billing, which obviously is transferred to higher costs for all. Lawyers are one of the few hammers to get insurance companies to properly pay out, keep hospitals from devolving into managerial corruption, and keep Drug/Device companies from fudging the numbers.
- And the AMA/Providers are incentivized to maximize the billing for their services, overbill for often superfluous services, resist any intermediate level profession (Nurse Practitioners, etc) from devaluing their law-enforced professional monopoly, and incentivized to not address general health of patients but rather bill with expensive specialist care rather than help patients maintain wellness that averts serious illness. In my experience no provider ever cared about how much their services cost the patient, until it became apparent the patient could no longer pay. Then their economic awareness of the cost of care become VERY APPARENT. The AMA is criminally complicit in restricting supply of doctors, which it very well knows raises the cost of medical services and of course denies care to people on the aggregate.
Each of the four pigs simply points to other pigs as someone to blame and lobbies with maximum force to prevent any threat to their gravy train.
To address US healthcare costs will generally require all four pigs: a public insurance option (at a minimum). Reduce patent length or invalidate patents, and with cases like unpatented production that has been monopolized (epipen, insulin) enforce antitrust. Fix prices if necessary. Obviously trial lawyers awards should be capped. Finally, nurse practitioners and AI expert systems used to decrease costs, and supply of doctors increased vastly. Overall, government needs to address the total lack of preventative care.