My own feeling is that the basic business model is just wrong—it’s insurance-based. Insurance should shield one from catastrophe, not provide a middle-man for routine transactions between a consumer and provider. The insurance industry’s presence distorts everything: what is coverable, how much should be paid by or to each party, it adds cost without adding value in most cases. I think we really need a different model altogether, one that recognizes that while costs of healthcare are distributed unevenly between individuals, collectively they are predictable and manageable—and reducible with efficiency and value-per-dollar based efforts.