This issue has to be handled carefully by reform proponents. Otherwise leftist pols, in tacit collaboration with tech lobbyists who want to be paid to create an automated version of the current system, with reduced costs based on fewer workers and worse (rationed) service, may frame the issue as NHS-style single-payer vs. greedy doctors. Therefore it’s important to argue that the right kinds of reforms might greatly improve the quality of medical care AND the patient’s experience, as well as reduce costs. Mead doesn’t quite make this case.
Currently one sees increased reliance (in the USA) on nurses and physician’s assistants to do things that physicians formerly did. This makes sense to some extent but there is a limit to the amount of skilled work that can be shifted away from physicians without degrading quality of care. The Obama model is to cut costs by overworking a smaller number of physicians while shifting as much work as possible to less-well-paid workers, making patients wait longer, reducing quality of care overall and expecting people to put up with it. The better alternative would lower costs and improve care by using technology to increase productivity.
The Obama model is hostile to the high-tech alternative because 1) the Obama people don’t have a clue about either economics or medicine and 2) high-tech reforms would contribute to decentralization and individual control of medicine, and Obamaism rejects decentralization and individual control on principle.