In point of fact, there is no real market reward for being a high qualty, low cost provider. The Mayo clinics aside, most communities have average health care systems that produce average results at high cost.

The only way that we can get to a better system is to create a “real” system by reducing the number of funding sources (preferably to one) and setting standards for providers at a national level.

If we do this, we can all then focus on quality instead of payment and those who produce better results will remain in business and those that don’t won’t. If we continue as a country to allow thousands of payers and thousands of independent and unregulated providers, we’re going to continue to get average quality at a high price.

In a single payer world, quality improves not because the providers somehow get better but because resources are allocated in a utilitarian way–thus diabetes and other chronic conditions get the lion’s share of funding while acute episodes that are not life-threatening have more limited access.

In a world where a budget is set, a nation can spend its time worrying about where to allocate limited resources and thus focuses those resources where they will do the most good.

This is how quality is improved across a population. You’re right to question whether we should be talking about quality or money. I don’t know how you’d change that conversation, but I know I would. It’s single payer, it’s regulated providers. It’s that simple. Whether we ever get there is anyone’s guess, but we’re stumbling toward it by pricing everyone out of the market.