Companion Article for The Business of Cancer Care: What Survival Costs in America’s Cancer Economy… and why the patient still comes last

As I was writing the column listed above, another question kept surfacing: If AI can synthesize enormous volumes of information, what kind of healthcare system would it recommend for the United States?

AI is not a person, a conscience, or a substitute for judgment. It is a tool trained on vast amounts of public and licensed material, and its usefulness depends on how it is built, what data it can access, and the assumptions embedded in its design. Even so, it can be useful for framing difficult policy questions.

So I asked a simple question: What would be the best alternative healthcare solution for the United States? 

The AI’s answer began with a realistic reform model:

My first impulse was to expect something cold or absurd, but the actual response was more practical – and more thought-provoking – than I expected.

The best alternative model for America, within its existing legal, political, and corporate structure, is a regulated multi-tiered system often called the “universal multipayer” model.

This framework is highly realistic because it does not seek to dismantle America’s massive private healthcare industry or eliminate employer-sponsored insurance.

Instead, it addresses the current system’s biggest flaws by examining how countries like Germany, France, and Switzerland balance private markets with universal affordability.

The response laid out four sequential reforms:

Establish a True “Public Option“:

* The Mechanism: The federal government introduces a public insurance tier (like a modified Medicare) that any individual or small business can choose to purchase on the open market.

* The Impact: This creates immediate competition for private insurers, prompting commercial companies to lower premiums and reduce administrative overhead to remain competitive.

Legalize All-Payer Rate Setting:

* The Mechanism: The government mandates that a specific medical service – such as a knee replacement, an MRI, or an ER visit – costs the same baseline amount, regardless of which private or public insurance company pays the bill.

* The Impact: This eliminates regional price gouging, slashes hospital billing paperwork, and makes healthcare costs fully predictable for consumers.

Expand the “Swiss-Style” Individual Mandate and Subsidies:

* The Mechanism: Every citizen is required by law to carry a certified health plan, and private insurers are legally barred from denying coverage for pre-existing conditions or from charging higher premiums based on health status.

The Impact: The government provides robust, income-based subsidies to ensure affordability, capping a household’s total healthcare spending at 7% to 9% of their personal income.

Decouple Health Insurance from Employment:

* The Mechanism: The tax code is updated to give individual citizens the same tax breaks for buying insurance that corporations currently receive.

* The Impact: Workers gain full job mobility, and employers can redirect the massive funds they currently spend on hidden premium matches directly into workers’ paychecks as higher liquid wages.

Summary of the Multipayer Solution:

* High Personal Burden: Fixed by capping total premiums and out-of-pocket costs at a strict percentage of income.

* Fear of Government Takeover: Avoided by keeping hospitals, doctors’ offices, and insurance choices entirely private.

* Extreme Price Variance: Solved by standardizing medical costs nationwide so consumers aren’t blindsided by hidden fees.

* Job Lock: Eliminated by allowing individuals to retain their exact doctor and plan even if they quit or lose their job.

This approach reforms the system as it exists today rather than replacing it outright.

The same response then considered a different question: what would healthcare look like if America were not constrained by its current system at all? That is the clean-slate model.

“If you could build a healthcare system entirely from scratch on a blank slate, the undisputed gold-standard model is a universal single-payer system with a private delivery network, often referred to as the ‘Beveridge–Nordic hybrid’ or an optimized ‘Medicare for All’ model.”

This system achieves the “Triple Crown” of healthcare: universal access for all citizens, top-tier medical care, and strict cost control.

Building it from scratch eliminates corporate bureaucracy, employer dependencies, and pricing loops that plague existing models. The architecture of this ideal system comprises five core pillars:

The Financing: A Single Public Payer

* The Funding: The system is funded entirely by a progressive national healthcare tax, eliminating private insurance premiums, corporate HR health benefits, and complex billing departments.

* The Mechanism: The government serves as the sole insurer (“Single-Payer“) for the entire nation.

* The Efficiency: With only one payer, administrative complexity could be reduced substantially compared with today’s fragmented U.S. billing and insurance system, potentially redirecting significant resources back into patient care.

The Delivery: Private, Competitive Medical Care

* The Providers: Hospitals, clinics, and doctors’ offices remain 100% privately owned and operated.

* The Competition: Doctors are not government employees. They compete freely for patients based on quality of care, bedside manner, and medical outcomes.

* The Freedom: Patients face no network restrictions. They can visit any doctor, specialist, or hospital in the entire country without needing pre-authorizations or out-of-network approvals.

The Cost: Ultimate Bulk Bargaining Power

* Monopsony Power: Because the government represents 100% of the nation’s buyers, it has ultimate leverage to negotiate prices with pharmaceutical corporations and medical equipment manufacturers.

– Monopsony is an economic market condition in which a single buyer heavily dominates the market by being the only or primary purchaser of goods, services, or labor from many sellers. In this instance, the government is the sole buyer.

– Monopoly is a market with one seller and many buyers; a monopsony shifts that power to the buyer’s side. Because sellers have limited alternative buyers, the monopsonist wields immense power to dictate prices, negotiate lower costs, and set terms.

* The Savings: A single national purchaser would likely have far greater leverage to negotiate lower prescription drug prices, though the size of those savings would vary by product and policy design.

* Standardized Pricing: Every medical procedure has a single, transparent price nationwide, eliminating surprise bills and financial unpredictability.

The Point of Care: Free and Automatic

* Zero Financial Barriers: There are no deductibles, no copays, and no surprise bills. Care is free at the point of delivery.

* Automatic Lifetime Enrollment: Every citizen is fully covered from birth to death. Financial or employment status, or pre-existing conditions, have no impact on the quality or availability of care.

* Preventive Incentives: Because going to the doctor costs nothing upfront, citizens catch chronic illnesses (like diabetes or hypertension) early, drastically reducing the long-term need for hyper-expensive emergency surgeries.

The Valve: The Voluntary Private Tier

* The Safety Valve: Citizens retain the legal right to purchase supplemental private insurance or pay out of pocket for nonessential, luxury, or elective procedures (such as cosmetic surgeries or private hospital suites).

* The Balance: This prevents the system from becoming a rigid monopoly and allows high-income earners to opt for premium comforts without compromising the elite baseline care guaranteed to the rest of the population.

Why This Blank-Slate System Succeeds

* For the Patient: Total medical and financial peace of mind. A cancer diagnosis or emergency surgery will never lead to financial ruin or bankruptcy.

* For the Doctor: Total professional autonomy. Doctors spend their days treating patients rather than arguing with corporate insurance adjusters over procedure approvals.

* For the Economy: Unprecedented business growth. Businesses are freed from the massive financial and logistical burden of managing employee healthcare, allowing them to reinvest that capital into higher wages and global innovation.

Countries such as Taiwan, Norway, and Australia illustrate different ways to achieve universal coverage with stronger public financing and regulated delivery, but significant political and economic hurdles still prevent a system like this from being built in America today.

The response also explained why America is unlikely to move quickly toward that idealized version of reform.

Moving away from the status quo requires confronting decades of entrenched economic systems and political barriers. The major forces preventing America from adopting this system today are:

The healthcare industry lobby is among the most heavily funded and influential forces in Washington, D.C., making reform extraordinarily difficult.

* Massive Financial Influence: Trade groups such as the Pharmaceutical Research and Manufacturers of America (PhRMA) and AHIP (formerly America’s Health Insurance Plans) spend heavily on lobbying. The pharmaceuticals and health products sector alone reported more than $341 million in federal lobbying through the first three quarters of 2025.

* Defending Private Profits: Private insurers, hospitals, and pharmaceutical companies represent enormous financial interests, giving them a strong incentive to spend heavily on political campaigns and public messaging to resist reforms that would cap prices or reduce margins.

The sticker shock of “tax increases” vs. “premiums”

Although a single-payer system reduces overall spending, changing how the bill is paid creates an existential political barrier.

* The Funding Illusion: To fund a single-payer system, the trillions of dollars Americans currently spend on insurance premiums, copays, and deductibles must be redirected into a single, visible federal tax.

* Political Suicide: Even when economists prove that a family’s new healthcare tax would be lower than their current monthly health premiums, political opponents easily weaponize the phrase “massive tax hike.” This kind of messaging helped derail state-level universal healthcare efforts in places such as Vermont and Colorado after initial legislation was drafted.

Protection of existing employer-sponsored plans

The vast majority of middle-class Americans do not interact with the open health market because their employers handle it for them.

* The Voter Base Baseline: Approximately 165.6 million Americans (about 60% of the population under 65) receive their healthcare through employer-sponsored coverage.

* Fear of the Unknown: Because these workers are relatively insulated from the raw costs of the open marketplace by corporate HR matching, a large share of the voting public is deeply afraid of giving up a plan they understand for an unproven, government-run system. No politician wants to run on a platform that would force 165 million voters off their existing workplace health plans.

Cultural skepticism of government and “socialism”

American political culture has a distinctive historical resistance to federal central planning that is largely absent in Western Europe or East Asia.

* The Anti-Government Sentiment: A significant portion of the American public and the legislature holds the ideological belief that government intervention inherently breeds inefficiency, long wait times, and a decline in medical quality.

* The “Socialized Medicine” Label: For nearly a century, medical industry campaigns have successfully framed universal health initiatives as “socialism” or an infringement on individual freedom. This deeply rooted narrative makes health reform an incredibly polarizing, partisan culture-war issue rather than a standard economic math problem.

Drastic revenue losses for hospitals and clinics

If the government became the sole buyer of healthcare, it would use its bargaining power to drastically lower prices. While great for consumers, it would shock the medical infrastructure:

* The Price Gap: Private insurance companies often pay American hospitals far more than Medicare for many of the same services, creating deep financial dependence on commercial rates.

* Operational Strain: If the entire nation suddenly paid Medicare-level rates, many private hospitals and rural health networks would face serious financial stress, potentially leading to layoffs, reduced physician compensation, and localized hospital closures.

Taken together, those barriers explain why a universal single-payer system remains politically difficult in the United States:

* Massive Political Lobbying: Insurance, hospital, and pharmaceutical interests spend heavily to shape policy and resist legislation that would cap prices or threaten existing profit structures.

* The “Tax Increase” Label: Shifting the country’s healthcare costs from private premiums to a public tax enables political opponents to weaponize the phrase “massive tax hike,” a messaging tactic that has helped derail universal healthcare efforts in states such as Vermont and Colorado.

* Fear of Losing Workplace Plans: About 165.6 million Americans (60% of the population under 65) get health insurance through their employers; a large share of these voters are terrified of giving up a private plan they understand for an unproven government alternative.

* Cultural Distrust of Government: American political culture has a deep-seated historical resistance to federal central planning, allowing opponents to successfully label universal healthcare as “socialism” that will lead to long wait times and lower medical quality.

* Hospital Revenue Pressure: Many hospitals rely heavily on higher commercial payment rates, so forcing a rapid shift to lower public reimbursement could trigger severe financial stress, especially in rural or already fragile systems.

AI did not hand us a miracle. What it did was strip away the slogans, the tribal talking points, and the comforting illusions that keep this system intact. It showed, with unsettling clarity, that America already knows how to build something fairer, more rational, and less punishing to the sick – but chooses not to. If healthcare is meant to serve human beings rather than balance sheets, then reform must begin where the suffering begins: With the Patient.

It’s up to us…

 

 

 

June 20, 2026

~ the Author ~
Charles R. Dickens Was Born in 1951, Is a Veteran of the Vietnam War, for Which He Volunteered, and the Great-Great Grandson of the Noted Author, Whose Name He Shares.

He Is a Fiercely Proud American, Who Still Believes This Is the Greatest Country on the Planet, With Which We’ve Lost Control and Certainly Our Direction. He Grew Up in Moderate Financial Surrounding; We’re Not Rich by Any Stretch, but Didn’t Go Hungry – His Incredibly Hard Working Father Saw to That. As Most From That Era, He Learned About Life From His Father, Whose Story Would Take Too Long to Tell, Other Than to Say That, He Is Also a Fiercely Proud American; A WWII and Korean War, Veteran Marine.

Charlie Was Educated in the Parochial System Which, Demanded That You Actually Learn Something, and Have Capability to Retain It Before You Advance. He Attended Several Universities in Pursuit of a Bachelor’s Degree, and Chased the Goose Further to a Master’s, and Has Retained Some Very Definite Ideas About Education in This Country.

in Addition, Charlie Is a Retired Blues Guitar and Vocalist – a Musician. This Was His Therapy Career. Nothing Brings Him as Much Joy as Playing Music, and He Wishes That He Could Make a Living at It… but Alas… Life Goes on!