The backyard deer have moved to the front – and health care
Posted By RichC on June 17, 2026
For the most part, living with wildlife is mostly enjoyed, but the deer are often destructive. Still when seeing the spotted fawns trailing their mom, or the dad watching things from over the fence, it does make me smile.
Living with nature aside, the last couple of days for me have been dealing with doctors, appointments, scheduling and health insurance. There must be a better … and simpler … way to manage our medical care? I wonder what AI thinks?
If I Were Designing U.S. Healthcare from Scratch
My goal would be better health outcomes, lower total costs, less bureaucracy, and more patient choice. The current U.S. system spends far more per person than other developed nations while producing mixed results. The core problem is that incentives are fragmented: providers are often paid for volume, insurers for managing risk, employers for limiting premiums, and patients for navigating complexity.
The Core Principles
- Universal catastrophic coverage – no American should face bankruptcy from illness.
- Transparent pricing – patients should know costs before receiving non-emergency care.
- Competition where it works – encourage market forces for routine services.
- Public oversight where markets fail – especially for emergencies, monopolies, and essential care.
- Prevention first – invest heavily in keeping people healthy rather than only treating disease.
- Technology as infrastructure – AI, digital records, and automation should reduce administrative waste.
1. Replace the Insurance Maze with a Two-Layer System
Layer 1: Universal Catastrophic Coverage
- Every citizen is automatically covered for major medical events: cancer, heart attacks, trauma, intensive care, organ failure, etc.
- Funded through a dedicated health tax that replaces much of today’s employer-based premium burden.
- Eliminates medical bankruptcy and the fear of losing insurance when changing jobs.
Layer 2: Personal Health Accounts (PHAs)
- Each person receives a tax-advantaged account for routine care, prescriptions, dental, vision, and elective services.
- Government contributes for low-income citizens; others contribute directly.
- Unused balances roll over and can be invested, encouraging cost-conscious decisions.
2. Pay Doctors for Outcomes, Not Volume
Current fee-for-service payment rewards more tests and procedures. I would shift to:
- Bundled payments for episodes of care (e.g., a knee replacement includes surgery, rehab, and follow-up).
- Outcome-based bonuses tied to recovery rates, patient satisfaction, and complication rates.
- Primary care capitation where physicians are paid to keep patients healthy, not just to treat illness.
3. Radical Price Transparency
Every hospital, clinic, and pharmacy would be required to publish:
- Cash prices
- Insurer-negotiated prices
- Quality metrics
- Expected out-of-pocket costs
A simple national app would allow patients to compare providers the way they compare airline tickets.
4. Use AI to Eliminate Administrative Waste
Administrative costs consume an estimated 20–30% of U.S. healthcare spending. AI could:
Current Problem AI Solution Prior authorizations Instant evidence-based approvals Medical coding Automated coding from clinical notes Billing disputes Standardized digital claims Duplicate tests AI alerts using shared records Appointment scheduling Intelligent self-service systems The savings could be redirected to patient care and lower premiums.
5. Create a National Health Data Infrastructure
Every citizen would own a secure, portable electronic health record.
- Accessible by any authorized provider.
- Patients control permissions.
- Built on open standards to prevent vendor lock-in.
- AI tools can analyze records to identify risks and suggest preventive interventions.
6. Invest Aggressively in Prevention
Many healthcare costs stem from chronic diseases such as diabetes, heart disease, and obesity. I would:
- Provide free annual preventive screenings.
- Subsidize gym memberships and nutrition programs.
- Use AI-driven personalized health coaching.
- Offer insurance premium reductions for measurable health improvements.
7. Reform Prescription Drug Pricing
- Allow direct negotiation for medications covered under catastrophic coverage.
- Encourage faster approval of generics and biosimilars.
- Require pricing transparency throughout the pharmaceutical supply chain.
- Reward truly innovative drugs with stronger patent protection while limiting abuse of patent extensions.
8. Strengthen Primary Care
The U.S. underinvests in primary care. I would:
- Increase reimbursement for family physicians.
- Expand nurse practitioner and physician assistant roles where appropriate.
- Use telemedicine as a standard option for routine care.
- Place primary care clinics in underserved communities.
9. Simplify the Patient Experience
A citizen should be able to:
- See all coverage and costs in one app.
- Book appointments online.
- Receive AI-assisted triage before visiting a doctor.
- Get prescriptions, lab results, and follow-up instructions digitally.
- Appeal decisions through a fast, independent review process.
What Would This Achieve?
Goal Expected Impact Reduce administrative costs Save hundreds of billions annually Universal catastrophic coverage End most medical bankruptcies Price transparency Increase competition and lower routine care costs Outcome-based payment Improve quality and reduce unnecessary procedures Preventive care investment Lower long-term chronic disease burden AI-enabled operations Faster, simpler patient experience The Biggest Trade-Offs
No system is perfect. This model would require:
- Significant transition costs from the current employer-based insurance system.
- Political agreement on funding mechanisms.
- Strong privacy protections for health data.
- Careful regulation to prevent AI errors and algorithmic bias.
The Bottom Line
If starting fresh, I would design a system that guarantees protection against catastrophic illness, gives individuals more control over routine healthcare spending, uses transparent markets where possible, and deploys AI to remove administrative friction. The objective would be universal access, lower costs, better outcomes, and a healthcare experience that feels as simple and understandable as modern online banking rather than the fragmented maze many Americans face today.
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