Beyond Medicare For All: Cracking the Code of the Healthcare Affordability Crisis

Description

The U.S. healthcare system is in crisis — and the familiar solutions aren't working. Single-payer advocates and free-market defenders have spent decades talking past each other while costs spiral, primary care collapses, and millions remain underinsured. In Beyond Medicare For All: Cracking the Code of the Healthcare Affordability Crisis, veteran healthcare journalist Ken Terry offers something neither side has managed to deliver: a bold, practical, and politically workable path to universal, affordable care.

Building on his groundbreaking 2020 book Physician-Led Healthcare Reform, Terry introduces a new financing framework that doesn't require dismantling private insurance or expanding the federal government's role in delivering care. Instead, he proposes a layered model in which competing primary care groups take financial responsibility for basic care through a subscription model — while restructured health insurers cover hospital, post-acute, and higher-cost outpatient services. Employer and government subsidies ensure that no one is priced out of coverage.

What Makes This Model Different:

• Primary care reimagined: At-risk basic care groups manage population health and control costs — rescuing a specialty on the verge of financial collapse.
• Global hospital budgets: Modeled on Maryland's proven approach, hospital budgeting creates strong incentives for cost discipline across health systems.
• Insurance market reform: Restructured coverage pools make insurer participation viable and profitable — without sacrificing consumer protections.
• Emerging challenges addressed: Health IT, rural healthcare, social determinants of health, and a novel proposal for slowing technology-driven cost growth round out the framework.

With a foreword by health policy expert David W. Johnson, Beyond Medicare For All is an essential resource for physician leaders, healthcare executives, policymakers, and engaged citizens who are ready to move past the debate — and start building a system that works.

About the Author

Ken Terry

Ken Terry, the author of two previous books on healthcare reform, has been writing about the healthcare field for more than 30 years. As a senior editor at Medical Economics from 1993–2007, he covered many aspects of medical practice and the healthcare business, including managed care and information technology. In 2008, Terry began freelancing for such publications as Medscape Medical News, WebMD, cio.com, InformationWeek, and Fierce Healthcare.

Terry's first book, Rx for Health Care Reform (Vanderbilt University Press, 2007), won acclaim from several health policy experts and a favorable review in the Journal of the American Medical Association. Joseph E. Scherger, MD, then a professor at the University of California, San Diego, called the book "just the kind of bold analysis needed today to put reason and common sense back into health policy." The American Association for Physician Leadership in 2020 published Terry's second book, Physician-Led Healthcare Reform: A New Approach to Medicare For All. Tom Bodenheimer, MD, MPH, founding director of the Center for Excellence in Primary Care, said this book "offers an encyclopedia of knowledge on the U.S. healthcare system, written in an engaging, popular style."

Terry also helped write Stephen K. Klasko's 2023 book, Feelin' Alright: How the Message in The Music Can Make Healthcare Healthier. In addition, he contributed to a 2016 book about population health management by several executives of IBM Watson Health.

Terry recalls how his baptism by fire at Medical Economics ignited his interest in fixing the healthcare system. When a friend got him hired at the magazine, the editor at the time, Steve Murata, was unconvinced he could do the job. So Murata threw at him the hardest, gnarliest assignments he could think of, including pieces on how preventive care and medical advances raise health costs. Terry survived and thrived, and this book presents everything he has learned about healthcare since then.

Table of Contents

Dedication

Acknowledgments

About the Author

Foreword: Healthcare's Incentive Problem

Introduction: The Runaway Train of Health Costs

Part 1: Why Healthcare Is a Mess

1. The Corporate Grip Tightens
   • Prices Are About Market Power
   • Physician Employment
   • Other Employment Alternatives
   • Consolidation and Sustainability
2. A Clinical Workforce in Distress
   • The Downsides of Vertical Integration
   • The Clinical Workforce
   • The Decline and Fall of Primary Care
   • Primary Care Solutions
   • Conclusion
3. What Is the Value of Value-Based Care?
   • Has the Physician Mindset Changed?
   • The Origins of Value-Based Care
   • Why Many Physicians Have Not Embraced VBC
   • Insurers Push Forward with VBC
   • Conclusion
4. Recent Proposals to Save Healthcare
   • Government-Based Solutions
   • Basic Care Approach
   • 'Social Floor' Guarantee
   • The Market Will Fix It
   • The Consumer and Technology Will Fix It
   • Tiered Use of Technology
   • Conclusion

Part 2: Restructuring Healthcare

5. Splitting Insurance in Half
   • How to Restructure Healthcare Financing
   • Maryland's Grand Experiment
   • Expanding the Maryland Model
   • Conclusion
6. Liberating Primary Care Physicians
   • Primary Care Is the Key
   • Getting Ready for the New System
   • Managed Competition
   • Provider Report Cards
   • Conclusion
7. How To Organize Basic Care Groups
   • Blueprint for Care Delivery
   • Infrastructure Requirements
   • Financial Risk
   • Key Measurements
   • Conclusion
8. Waste Not, Want Not
   • Overtreatment and Undertreatment
   • Quality Issues and Misdiagnosis
   • Care Coordination
   • Guidelines and Measures
   • Choosing Wisely
   • Primary Care Scope of Practice
   • Conclusion
9. Population Health Management
   • Making the Population Healthier
   • Primary Care Shortage Redux
   • The Many Sides of AI
   • PHM Infrastructure
   • High-Risk Versus Whole Population
   • Continuum of Care
   • Patient Engagement
   • Conclusion

Part 3: Ramifications

10. Technology in Healthcare Reform
    • Telehealth Can Be a Lifeline
    • E-Visits Improve Access
    • Mobile Health Apps in Patient Care
    • Remote Patient Monitoring Grows
    • Future Visions, Current Realities
11. Saving Rural Healthcare
    • Rural Hospitals on the Brink
    • Physician Shortages and Rural Clinics
    • Value-Based Care in Rural Areas
    • A New Vision of Rural Care
12. Addressing Health-Related Social Needs
    • How to Meet Patients Where They Are
    • Provider SDOH Programs
    • How Payers View SDOH
    • Racial Health Disparities
    • Role of Value-Based Care
13. Technology and Health Spending
    • Technology's Effect on Costs
    • Medical Devices, Tests and Procedures
    • Prescription Drugs
    • Why Are Drug Prices So High?
    • Fighting High Drug Prices
    • Taking Responsibility for Drug Costs
14. What We Owe Each Other
    • The Great GLP-1 Controversy
    • Cost-Effectiveness Analysis
    • International Comparisons
    • New Directions for Technology Assessment
    • How Patients Can Be Involved

Afterword: A New Deal for Healthcare

References