After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. Yet, I am also a physician struggling within the confines of our current health care system and, by virtue of my residency program, I have had the opportunity to see how different health care management systems in three different hospitals (public-county, private, VA) can fuck everything up. On the flip side, I suspect that I have a lot to lose financially if health care reform passes, and will have to forgo my dreams of paying off my medical school loans before I turn 65.

Because proper cost data are so critical to overcoming the many barriers associated with legacy processes and systems, we often tell skeptical clinical leaders: Cost accounting is your friend.” Understanding true costs will finally allow clinicians to work with administrators to improve the value of care—the fundamental goal of health care care

There’s more: the government sets what drugs within each class can be prescribed in this system (and makes it more difficult to obtain so-called non-formulary” drugs, those that are basically not as cheap as the ones the government gets after negotiating with drug companies), it utilizes its own electronic medical record, and it inserts an oddly musky smell into the hallways of the hospitals it runs.

Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called a Medicare-for-all, single-payer health care system,” and he said 16 Democratic senators supported it. Those included Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, Kirsten E. Gillibrand of New York and Kamala Harris of California — all names on the list of possible candidates for president in care

The only way to alter the self-fulfilling, destructive course that Trump has set us on is for senators to publicly say that they will never vote for a bill that robs people of coverage and to tell the administration to undo the Trump tax, stop the antics that are driving instability in the exchanges, and do the real work of improving Americans’ access to high-quality health care