The transformation began with the enactment of Medicare and medicaid during the Johnson years — which allowed prices to be contained as a growing percentage of bills were paid by large entities, especially the government — and the HMO act during the Nixon years — which endorsed the idea of an efficient system where experts decided on how to treat any problem, effectively setting limits on volume.
Once the tools were in place to control both price and volume, the rest was just fine tuning, which is still ongoing. The basic principles were ratified in Obamacare and are no longer under serious challenge. The change hasn’t relied entirely on government action, but reflects private sector movement in the same direction. Continue reading The war to reform American medicine has been won.