This is not surprising because we do not have a healthcare system at all. Our non-system is merely a very complicated series of access points that have been created or evolved over many decades in a piecemeal manner without the benefit of an overall design or strategy to guide the process. Because we have a non-system, we have mindboggling complexity, misaligned incentives, unfathomable cross subsidies and the most expensive and least effective healthcare in the developed world. The complexity of our non-system is, in and of itself, a serious obstacle to reform. The proposals floated in the recent Democratic 2020 Presidential Debates have primarily served to highlight the lack of a clear definition of the problem or a clear objective for reform that addresses the underlying cost problems and goes deeper than the slogan level.

Sensible Health Care Reform is a comprehensive multi-dimensional and multi-year program that is based on an evidence-based definition of the problems we face as a nation. The program has as its clear objective “to continually improve the health of all Americans while systematically reducing national health care spending”. This objective cannot be achieved simply by incremental changes to Obamacare or by moving to one of the Medicare for All proposals now being promoted by some 2020 Democratic hopefuls. And while President Trump has already issued two Executive Orders that are positive steps, the Administration has not yet defined a program for comprehensive reform. Moreover, little attention has been paid to how to deal with the nation’s extremely high incidence of chronic disease caused by unhealthy lifestyles and exacerbated by our aging population. These exogenous factors will continue to drive national healthcare spending and call for immediate action.