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Atul Gawande, founder of Ariadne Labs, has been working for years to innovate healthcare delivery, and he will soon lead a new joint healthcare venture for Amazon, JPMorgan Chase and Berkshire Hathaway to not only reduce costs but improve care as well. The passage of the 2010 Affordable Care Act has increased the proportion of the U.S. population covered by health insurance, but the country still lags far behind other wealthy countries when it comes to healthcare penetration and efficacy. Judith Feder, a professor at Georgetown University’s McCourt School of Public Policy, says, “What drives the cost [of healthcare] is not trying to cover the people who don’t have insurance, it’s what we pay for the people who do have coverage.” In other words, the Haves drive up spending, while the Have-nots bring down key health measures. Currently there is no incentive in the system to provide good care; the only incentive is to provide lots of care. To cope with rising costs, employers have passed more onto workers, which is why wages have remained stagnant and the delivery system has seen little change. Some potential solutions include on-site or nearby clinics for employees to use during work hours, which can help reduce lost productivity and the hassle of making appointments. Gawande and others believe that misaligned incentives are the biggest problem of the U.S. healthcare system, and a new system could ensure doctors receive a flat monthly fee for each patient, instead of for individual visits and treatment.

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