As the U.S. health care system has evolved over time, the patchwork of laws, various coverages, cost-reducing/increasing activities, provider and insurance companies coverages/rates, etc. can often seem onerous and broken. Further, embedded concepts and behaviors exacerbate problems within the system and cannot simply be reversed.

To fix the U.S. health care system will take time but it can be done. In my view, there are seven steps the U.S. can take to fix it.

Policymakers must recognize unanticipated reactions may occur as fixes are implemented and be ready to revisit the process by which change is implemented. Further, changes should be carefully monitored to ensure the outcomes remain beneficial. If change proves less successful, the ‘fix’ may need to be countervailed by yet more policy changes.

Seven Steps to Fix the U.S. Health Care System:

1. Reduce direct costs through restructuring workflows and reducing direct unit costs.
   As part of reducing direct costs, specifically reduce executive salaries and restructure the incentives for performance to be consistent with appropriate management incentives and goals and promote quality and value in care.
2. Reduce overhead cost through examining all specific indirect costs and their function for appropriateness for reduction or elimination.
3. Move as many costs and functions as possible to be variable costs, possibly outside the organization to allow for greater flexibility and adapt as the system evolves in the future and plan for volume flexibility.
4. Stick to the core businesses and avoid getting into areas in which an organization is not natively skilled (e.g. do not become an insurance company or take risk solely because one desires to control more dollars and therefore be the distributor of such dollars or because it is fashionable.
5. Expand/extend telehealth benefits indefinitely and require a secure interface.
6. Expand and support primary care and related practitioners as opposed to specialists.
7. Even executing a portion of these strategies over some time horizon will contribute to beneficial effects. However, any such changes at the provider level need to consider that these changes need to be made given that policy changes now or in the future will be made in a political environment.