Concierge medicine can be a good option for affluent people who can afford it. But it only works with relatively low utilization and won't scale up to address any of the systemic problems in the US healthcare system.

That doesn't apply to health insurance. Due to HIPAA / ERISA / EMTALA / ACA and an alphabet soup of other federal and state laws and regulations a startup health insurance company would have very little freedom of action on creating new types of contracts. And this is an area where the laws are actually enforced.

Dump $1 trillion into Kaiser and push it out to all 50 states. I have it in Bay Area and it’s mostly been great for me. It’s not the best but it also gets 90% of things right.

Congress fixes this or we continue to drag ourselves towards worse failure modes.

Vote and legislate. Doesn’t even have to be federal, since the exchanges are state run. But it’s a highly regulated industry (for good reason, this isn’t a place where deleting laws helps normal people), so you have to fix the regulation. The ACA killing pre-existing coverage denials was a great start, but you have to fix risk adjustment before anything else can happen, as it’s literally just a wealth transfer from new entrants to existing behemoths (I think it was well intentioned, and works well in MA, but is completely broken in the commercial market). Reinsurance fixes to address the fund lockup would also probably help, but they’d be tax-expensive and probably untenable.

But it all starts with voting for people who want to fix it, and not for people who just want to burn it down or maintain the status quo.

Will be consider mostly irrational, but I'll mention it:

Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons.

As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.

Educate humans (not possible because they have to want to learn). Abolish Citizens United. Stop funding insurance. Put the insurance money to healthcare for all.

So my four pigs analogy, where insurance companies, drug/device companies, doctors/hospitals, and lawyers all feed at the trough, increase costs and point to someone else (although I will admit lawyers are probably the smallest cost component and the most blamed by the other three).

There is a fifth one that imposes costs: our comprehensively unhealthy food, health, and lifestyle in America that capitalism feeds upon with addictive high-margin food and drink, with overworked workers that can barely have time to raise kids (our healthy demographics are due to immigration) much less a healthy lifestyle. The entertainment complex certainly doesn't help either.

Providers: you need comprehensive family care to avoid specialist care being needed, an increase in supply of doctors, decreasing their educational loan burden (which strongly incentivizes specializataion, and a system that involves specialists). I think advanced AI systems can do much more day-to-day tracking and diagnosis/information, but of course that is a personal information nightmare. Actually I don't mean advanced. I think current AI is plenty good enough. Unfortunately only insurance companies will employ these systems or pay for them.

Insurance: Probably need a medicare-for-all option. We were close to this with Obamacare but FUCKING JOE LIEBERMAN killed it. Exhibit A in why the Democrats with full control of government will never get anything done.

Drug/Device companies: reduce patents, I don't know, maybe allow price negotiation (which is just mind blowing in a "free market" economy), reform the FDA to make bringing drugs to market cheaper.

Lawyers: caps caps caps so there isn't costly malpractice insurance. Maybe would also necessitate a federal review board to weed out "bad doctors".

But the biggest is probably governmental direction to actually get people to be able to eat and live active lives. Maybe GLP-1 will help, but the quiet time bomb of increasing obesity in Americans each decade is probably a sneaky large amount of our costs.

Otherwise, on the nihilistic side, keep doing whatever our society is doing which is causing men to kill themselves in huge rates (soma ... uh... I mean opioids were also doing this as well) before they reach their ultra-expensive late stage of life.

Anyway, none of that is happening (except, sadly, the nihilistic solution is the most realistically happening).

Maybe setup huge provider networks across the border in Mexico and Canada served by high speed transit, so large portions of the world get health maintenance in functioning health care systems, and only do hospitalization and emergency care here?

Yeah, agreed. It has to start from legislation. And that legislation has to also address education - we have to make it easier and cheaper to become a doctor or mid-level, or we have to start trying to import a ton of providers.