Patients are willing to pay a fair price for quality health care and research and development for truly new advancements. What they are not willing to fund is the increasing percentage of our health care dollar that is going to greed, fraud, unnecessary care, private equity groups, PBMs, advertising, defensive medicine and excessive malpractice premiums, excessive provider and CEO salaries, government grants, and exorbitant insurance and pharmaceutical company profits. Unbeknownst to most, patients are also funding pharmaceutical or device manufacturer vouchers, rebates, coupons, copay reimbursement, provider trips, “free” medications, or sweetheart deals that allow pharmaceutical and device companies   to charge insurance companies and the government more than market value for their medications and devices.  The inflated cost of health insurance also stems from the need to pay health care, health insurance, and government employees who deal with coding, copays, coinsurance, deductibles, risk assessments, prior authorizations, creative billing, collections, appeals, denials, delays, auditing, utilization reviews, exclusions, health insurance policy “fine print,” and all other tasks associated with the administration of health care delivery. Just a reminder: these tasks are costly and do not provide actual patient care. Furthermore, Americans absolutely should not have to fund an insurance navigator or State Health Insurance Assistance Program (SHIP) to get insurance.  Americans should not need medical, legal, and accounting degrees just to understand insurance policies, claims and explanation of benefits (EOB’s). We also do not need a patient advocate or independent company to help with prior authorizations, billing issues, and “lost claims.” There is a metaphorical feeding frenzy for the health care dollar, and unfortunately, patients’ actual health care gets the crumbs.

While it is easy to recognize the problems with the American health care system, the most important question remains: What can we realistically do about them? Without change, we are headed straight for a collapse of the present unsustainable system, which would leave a few insurance companies, private equity groups and providers picking up the pieces for those able to pay and the government dealing with the rest. This ultimately means that a huge proportion of Americans would be left without health insurance or care.

To prevent the worst-case scenario from happening, Congress needs bipartisan support to allow health care to be devoted to benefiting patients again. Our free-market system will work if given the chance and if supported by choice and competition. We have seen the success of Walmart (except in primary health care, a field even this giant cannot master), Costco, Amazon, Apple, and Microsoft. They did not start by replacing or destroying existing markets but instead started out small and expanded by providing options for better, more efficient, and less expensive shopping and computer experiences. As a result, they outcompeted many independent bookstores and ultimately many large and well-established retail outlets like RadioShack and Toys “R” Us. I acknowledge that the result is that they have replaced, destroyed  or forever changed many well-established retail stores and mail-order companies. Nevertheless, we need to do the same with health care and start small with a better product and expand and  replace the current system with one that is patient-oriented, affordable, and capable of delivering care to all. Let us learn from the example of the cosmetic surgery field, which has never relinquished its control over either the medical or financial aspects of the patient–physician relationship.

Here, I write to you, the reader: Only citizens and patients with support from their employers and the government will be able to bring about the necessary changes. You need to let your congressional representatives know about the problems you are experiencing both financing and utilizing the present broken health care system. Payment models and incentives need to change. Only then can we get back to payers, including patients, employers, and the government, being in control of affordable health care for all. We need to transition health care from the defined benefit plan (all medically indicated care is covered by insurance) to a defined contribution plan, just like when employers switched from the defined benefit retirement plans to defined contribution 401K plans.

While some of the contents of this book may have painted a bleak picture of the current health care delivery system, I have every hope that change is possible. Over the years, I have seen many truly unbelievable advances in clinical medicine, and I have witnessed the amazing efforts of individuals and organizations working to deliver care around the world. I am optimistic that such advances can be made available, not only to those in the United States, but also people around the world. AI can be a great help to the physician but never a replacement. We must not forget we have only one life to live, and we cannot take with us to the grave our accumulated assets, such as financial investments in health insurance companies, Big Pharma, and private equity groups. I have had great satisfaction providing care for those in need on volunteer trips around the world and taking care of patients in need in Green Bay. HCPs need to remember that our first priority is taking care of ER patients and others at the most vulnerable times in their lives—when they are hurt, sick, in pain, and scared. We must help in times of need, not leverage situations where a life hangs in balance for undeserved financial gain.