Despite unprecedented spending and medical innovation, America’s healthcare system still falls short of delivering what matters most to patients and families. With the midterm elections approaching and healthcare reform on the national agenda, the need for a shared vision of what our healthcare system should achieve has never been more urgent. In this new op-ed, IVI President & CEO, Marc Boutin, argues that meaningful reform begins with a fundamental question: What should our healthcare system actually deliver for patients and families?
What Would a Better Healthcare Alternative Look Like?
President & CEO, IVI
No one in the United States is satisfied with the healthcare status quo. Not doctors. Not hospital executives. Not drug or insurance company leaders. And, most certainly, not patients.
Seventy percent of Americans think the healthcare system is either in a state of crisis or has major problems. Just 16 percent say they’re satisfied with the cost of care, the lowest share Gallup has ever recorded.
This nearly universal anger is setting the stage for seismic reforms. Voters are demanding sweeping changes. And policymakers in both parties are planning ambitious healthcare overhauls if they win the midterms and 2028 election.
Rather than waiting for Washington to impose changes from the top down, it would be far better for patients, providers, insurers, employers, drug companies and pharmacy benefit managers to work together now — to reimagine, and ultimately redesign, the system with a shared vision.
The United States boasts the most talented doctors and best hospitals in the world. Our researchers develop the lion’s share of medicines. And far more of those treatments are available here than in peer nations, at least in theory.
Despite these advantages, our healthcare system fails to deliver the outcomes that matter most to families because it was never designed to do so. We often cannot agree on what healthcare should ultimately accomplish, which outcomes matter most, or what tradeoffs we are willing to tolerate.
Without this shared understanding, companies default to prioritizing short-term finances, even when that doesn’t serve the long-term interests of patients, families or society.
For instance, consider the dilemma facing health insurers. Americans frequently bounce from insurer to insurer as they change jobs, move to other states, retire and enroll in Medicare, or select new plans that better fit their needs. People with commercial health coverage — obtained through employers or the Affordable Care Act exchanges — stay with their insurers for less than two years, on average. Americans on Medicaid managed care plans typically stay enrolled for well under a year.
Even when an expensive treatment would clearly improve a patient’s health and prevent future complications, the insurer or employer that shoulders the upfront cost likely will not reap the eventual savings.
Consider the dilemma posed by gene therapies, which target the underlying genetic malfunctions and mutations that cause certain diseases.
In many cases, a one-time dose of these therapies can cure a patient’s disease for life and prevent millions of dollars in spending on hospitalizations and other care down the road. The Institute for Clinical and Economic Review, a think tank known for scrutinizing drug prices, has concluded that multiple gene therapies are cost-effective, even with price tags exceeding $1 million.
In all likelihood, insurers that cover these therapies will see only a fraction of the return before patients switch plans. They have a strong incentive to limit access, even when everyone agrees these treatments offer good value over a lifetime.
This behavior makes sense from the perspective of an individual insurer or employer. It makes no sense for society as a whole.
America essentially needs the coordination benefits that single-payer systems provide in theory, without the rationing they often resort to in practice. We need a genuinely market-based system in which providers, drug companies and insurers can transparently compete for customers on price and quality.
That competition cannot happen unless we first adopt new valuation metrics to better understand the full costs and benefits of different treatments and care models, and then redesign payment and insurance rules so organizations are rewarded, rather than penalized, for investing in patients’ long-term health.
Once the United States starts measuring healthcare differently, we will begin designing and delivering it differently too. We will reward coordinated care that produces the outcomes families value, prioritize earlier interventions, and make treatment regimens more logistically and financially manageable. Innovators will gain a clearer picture of what society rewards, while payers will compete on long-term outcomes rather than minimizing short-term use and hoping somebody else gets stuck with the eventual bill.
Everyone recognizes that the healthcare status quo is unsustainable. The question is whether stakeholders can set aside their differences, agree on a shared definition of success, and implement reforms that improve patients’ long-term physical, mental and financial health while allowing their families to remain stable and whole.
If they cannot, Washington will eventually impose changes from above.
Originally published online by DC Journal on October 30, 2026.
