HJNO Jan/Feb 2026

WHAT’S WRONG WITH HEALTHCARE 18 JAN / FEB 2026 I  HEALTHCARE JOURNAL OF NEW ORLEANS   and outcomes is supposed to work? It is inter- esting to note that even more than 30 years ago, Carville’s sign reminded the campaign staff not to forget about healthcare, meaning that the unaffordability and other problems af- flicting healthcare were notably important back then. Those same problems have only gotten worse in the decades since. In healthcare, the combination of excessive costs, variable quality, access problems, and, sometimes, poor patient experience, would suggest that we are getting it wrong far too often, thereby creating anxiety and frustration for all participants. No one seems to be happy with the current system — not patients, who worry about the cost of insurance and difficulty obtaining adequate access to both primary and specialty care; not employers, who face esca- lating premiums that they have to pass down to their increasingly unhappy employees; not providers, who are struggling with burnout while their incomes are getting squeezed, and whose professional judgments are questioned as they navigate a maze of administrative bu- reaucracy; not hospitals and health systems, who find themselves managing increasing labor and supply costs on ever decreasing margins; not health plans, who are routinely vil- lainized (not to mention the lives of their execu- tives threatened in an all too real way); and not state and federal governments, whose health- care budgets are spinning out of control due to exorbitant healthcare costs (as evidenced by the recent government shutdown and debates over continuation of Affordable Health Care Act subsidies). Nobody seems to be happy with healthcare. And too many of the proposed solutions to these problems have been focused narrowly, typically on only a few dysfunctional aspects of the system. Some would blame runaway healthcare costs on drug companies and medi- cal device manufacturers, while asserting that controlling these costs can only come by ne- gotiating lower prices. The problem with that logic is that only the federal government is large enough to negotiate those prices down- ward, which could risk stifling the development of new market-based innovations. Some would advocate for a complete gov- ernment takeover of healthcare where the gov- ernment provides universal insurance with the power to control costs by negotiating lower prices for services as well. Others would assert that it is more a matter of personal responsi- bility and accountability, and that solutions lie in money going directly to healthcare consum- ers — rather than payers — thus empowering patients to act as consumers by giving them a large personal stake in the cost of their care. Still others believe in the power of technology as a panacea to solve all the woes of health- care. I believe all of these solutions are flawed to some degree. Take the electronic health re- cord (EHR) for example. In 2009, as part of the American Recovery and Reinvestment Act, the Healthcare Information Technology for Eco- nomic and Clinical Health (HITECH) Act was passed to accelerate adoption of information technology in healthcare, especially EHRs. The HITECH Act cost American taxpayers about $26 billion to encourage providers and health systems to move away from a paper-based medical record to an electronic one believing that would at least solve the fragmentation and care coordination issues of healthcare. The banking industry went through their own transformation where they moved away from paper and their old “bricks and mortar” model of having customers come to them and toward electronic mobile platforms where customers could do their banking from anywhere, only the taxpayers did not have to fund that transforma- tion. Why not? I would posit that in the banking industry, those banks that were slow to em- brace technology and mobile banking would have lost customers to those who did. For banks, accelerating adoption of technol- ogy was simply a cost of doing business. And mobile banking became a core component of a bank’s customer value proposition. In other words, those banks who failed to adopt tech- nology would quickly be rendered irrelevant and left behind — with the exception of serving one small niche of customers who preferred the “good old days” of going to the bank in per- son — which brings us back to healthcare. Why did healthcare require $26 billion of taxpayer money to encourage us to adopt information technology? I would propose it is because current eco- nomic structures have gotten the customer value proposition wrong. If the central promise of our healthcare system were truly to improve health and health outcomes per dollar spent, we would have adopted information technol- ogy as a basic cost of doing business — just as banks did — rather than waiting for a fed- eral bailout to drag us into the digital era. And we would have relentlessly developed and embraced new forms of measurement that closely track changes in health status and func- tional outcomes, because those metrics are the scoreboard by which our success or failure is judged. A NewWay of Thinking About Healthcare Neither the problem nor the solution to healthcare’s woes will be found in any single as- pect of the system or in any single bad actor. It’s not about bad doctors milking the system for their own financial advantage, although these actors do indeed exist. It’s not about hospitals and health systems living on large, fat margins at the expense of everyone else. It’s not about greedy health plan executives who are trying to ration care at the expense of their members while also trying to “stick it” to the providers. And it’s not about a “deep state” of govern- ment leaders trying to control every aspect of society to impose statism or socialism by way of medicine. None of these groups are the vil- lain; they are all rational actors responding to warped incentives. And warped incentives are an economic problem, not a moral one. I have read literally hundreds of books on healthcare. My all-time favorite of these books is Redefining Health Care: Creating Value- Based Competition on Results , 2 authored by Harvard Business School professor and man- agement expert Michael Porter and his former doctoral student Elizabeth Teisberg. They dis- tilled the problems of healthcare as primarily a failure of competition; in this case, the failure to compete on value provided to patients. Strategically, they divided healthcare issues into three broad areas: 1. Cost and access to health insurance; 2. The types of care that should be covered by insurance versus being the responsibil- ity of the individual; and 3. The structure of healthcare delivery itself. Of these three, they argued that it is the struc- ture of healthcare delivery that drives the cost and quality of the entire system, which in turn drives the cost of insurance and the amount of coverage that is feasible. If we do not fix how care is delivered, we will never fix what it costs — or what insurance costs. In a well-functioning market, competition drives relentless improvements in quality, cost, and value. Innovation leads to accelerated adoption of technology as companies compete