U.S. healthcare is not failing. It is producing exactly what it is paid to produce.
Fee-for-service pays per procedure, not per outcome. Insurance pays per denial avoided, not per life improved. Hospitals are paid for admissions, not for the ones they prevent. Pharma is paid for chronicity, not cure. Employer benefits hide the price tag.
Each of the five is rational at the actor level and catastrophic at the system level. The U.S. spends more per capita than any country and ranks last on outcomes among high-income peers.
The redesign exists — capitated care, outcome-linked reimbursement, transparent pricing — and is blocked not by science but by who currently captures the surplus.
Pay for the outcome, not the procedure. Watch behavior re-route in 18 months.