We’re Arguing About the Wrong Problem

Michael Koriwchak, MD

As the United States midterm elections approach, we’re hearing the same recycled narratives about health care reform.

Costs continue to skyrocket.
Access is uneven.
Solutions are politically safe—carefully designed to avoid the real problem.

So we debate:

• more insurance
• more regulation
• premium subsidies

But here’s the problem:

We’re not fixing health care.
We’re implicitly defending a financing system we don’t understand.

Health care and health care financing are not the same thing.

And that confusion has shaped decades of bad decisions.

If you get the financing wrong, everything downstream breaks:

• pricing
• incentives
• access
• even clinical care

We didn’t intentionally design a broken system.
We accidentally built one—and then spent decades patching it instead of rethinking it

Next: Our Current System is a Historical Accident