The 2025 US Health Care Crisis

Sen. Rand Paul recently published an article with his proposal to help the ailing United States health insurance industry.  LINK

 What Rand Paul is missing

Sen. Paul's article seems to frames the whole health industry issues in terms of "insurance price" and does very little to face the real issue: the state of the "health care system".   The major theme from the loudest libertarian advocate is that lowering insurance costs will result in lower health costs.  And thereby providing an unproven idea of a more efficient health care.   What is missing is a through analysis of and a modern vision of the true relationship between Insurance <-> Health Care.  

The basis for Sen. Paul's proposal is founded on libertarian economic theory that a free market with minimal government intervention is best for the whole.   The question is why should we believe this?  How does returning to a `free market` health system, ie. going back to pre Affordable Health Care, help to manage risk and efficiency any better?   It seems that we have done that, and been there with much pain. 

Sen. Paul, no one is going to get excited about a conversations over which `economic theory` is best.

The one thing that is clear and that we can all agree on is -- the need of `reducing price of health insurance;`;  but no further.

A bold healty vision for the modern health system

While many refuse to see the problems, chaos and abuses that exist in the health system today (see below) - it is clear that today we have the technology and the know-how to leverage AI, data and technology for delivering a healthy HEALTH SYSTEM.  Unfortunately, we lack leadership for the following:

1. Empower every individual with their own lifetime Individual Health AI Agent (IHAA)
   - my own smart AI agent that tracks and manages all health services,
   - that knows and uses my individual health history (and mine alone) for my benefit with my agreement,
   - that leverages large health models
   - that learns and manages my personal individual's risks,
   - to optimizing my annual services for benefit of the whole collective. 
2. Empower every provider with their own Provider Health AI Agent (PHAA)
   - an AI agent for each discipline,
   - that track the new records of each indvidual,
   - aids and guides personal human providers on the customers health,
   - improving efficency, speeding up services and lowering costs.
3. A national Amazon Health Supply Chain that interconnect EVERY 
1. individual, 
2. provider 
3. with disciplined health AI agents (DHAA)
4. Data is king with proper policies to manage protects of individual and collective, 
5. Health Care Efficiency is paramount guidance of each and the whole collection of AI Agents.

Seeing the problem(s) clearly

Today there is no clear vision for `maximizing the ROI on health care services`  that anyone, Republicans nor Democrats, has crystalized.  So lets map out some fundamentals:

1. The fundamental is that the core relationship of health system is between the Individual <-> the Provider

The lessons from the early 21st century shows that the models from the Amazon/Tech disrupters have been successful because they maximize/prioritize the benefits of the Individual <-> Provider relationship.  The infrastructure and supply chain of this relationship started small and scaled bigger and bigger till it covered the whole commerce landscape. 

Simple, like the commerce business model,  the supply chain has scaled to meet the demands of `the societal collective`.

Note that there has not been any need for intermediate `co-op collective agents` (ie. arbitary insurance collectives).   This is seen across all types of providers and all across ALL DISCIPLINES of `the marketplace`.

The key factor has been SCALING TECHNOLOGY (w/ now AI) & SUPPLY CHAIN MANAGEMENT of the recent 21st century disruptions. 

In simple terms,  the commerce supply chains connect Individual <-> Providers AT EVERY LEVEL.

2. We must be clear on the role of Insurace and RiskManaagement

The original goal and ROI proposition of insurance was too manage risk, ie. to scale illnesses across `the collectives` - at all levels:

1. individual risk: protect me from catestrophic risk
2. collective* risk: reduce the risk to productivity across a given collective
3. societal risk: to enable free markets while tracking the limits of 'affordability' accross the societyis (* = within a given organized institution: state, employer, "co-op", ins company, etc.)

The latest "affordability" pain levels relates to the chaotic dysfunction within the health system and it's supply chain.  

It needs to be said: today KAOS rules (utter disorder and dysfunction) across the whole health system. 

• Primary cause: too many hands in the "risk pie". 
• The annual "Insurance sign-up"step is extremely complex, too many options, too many handlers.
• The worst:  there is no rhyme or reason for choosing "one size all annual plans" that do NOT take into account an individual's actual known health history. 
• The illness risk is an 'lifetime' policy that gets convoluted by such complex systems and so many choices. 
• The risk pie has scaled beyond the technology and practices of the 19th century(one size fits all model).

3. The concept of  Choices is just a cover for Jim Crow insurance policies; it is the enemy of the risk pie.

The growth of choices only grows the management of risk at the expense of the health needs of the core relationship:  Individual <-> Provider.   The libertarians declare "choice" to be equivalent to "freedom" and the foundation of 'hands of the market'.   Bunk! Any market with so much hierarchy/layers, and hands in the pie reaches a point of diminishing returns without anyone able to control it. 

• Choice is illness killing risk management. 
• Setting up hierarchical risk choices only feeds more chaos and complexity. 
• Choices within the insurance industry is designed to drive profits for the few instead of efficiency for the maximum collective. 
• The argument: why should I pay a bigger share of the risk pie?  I'll go bake my own pie with lower risk.
• The impact to the societal collective is poison
• While choice paints a healthy ROI, the hierarchy classes cost the society in much greater proportions.
• Impacting all areas of our lives: production, civic, justice, etc..

4. Insurance has become the modern day taxation without representation

• The same American revolutionary sense is ALIVE - tax  the `higher risk` class (hierarchical) to deliver wealth to the  `lower risk` levels - not because there is inherent health risk but economic benefits - NOT HEALTH CARE. 
• The hierarchical system works on putting people onto the ladder based on pre-existing economic conditions.
• We need a declaration of Insurance Independence:
  
  When a long train of `abuses and usurpations`, pursuing invariably a `consistent pattern of events` (Insurance complex choices/requirements) that reveals a clear, underlying purpose to `reduce` high risk collectives under absolute Despotism, it is their right, it is their duty, to throw off such bounds from Insurance.