Imagine this: Healthcare — the whole system — for half as much. Better, more effective. No rationing. Everybody in. Because we all want that. And because we can. This can be done. Let me tell you how. I’m an industry insider, covering the industry for 37 years now, publishing millions of words in industry publications, speaking at hundreds of industry conferences, writing books, advising everyone from the U.N.’s World Health Organization, the Defense Department, and the Centers for Disease Control to governments around the world to, probably, your local hospital, your doctor, your health plan. The economic fundamentals of healthcare in the United States are unique, amazingly complex, multi-layered and opaque. It takes a lot of work and time to understand them, work and time that few of the experts opining about healthcare on television have done. Once you do understand them, it takes serious independence, a big ornery streak, and maybe a bit of a career death wish to speak publicly about how the industry that pays your speaking and consulting fees should, can, and must strive to make half as much money. Well, I turn 67 this year and I’m cranky as hell, so let’s go.

The Wrong Question

We are back again in the cage fight over healthcare in Congress. But in all these fights we are only arguing over one question: Who pays? The government, your employer, you? A different answer to that question will distribute the pain differently, but it won’t cut the pain in half.