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The illusion of reliable employer-based health insurance is crumbling;our safety nets have wide geographic variations;high-deductible insurance plans result in delayed care for people with chronic conditions;and underlying racial and geographic disparities in care are worsening 1β5 The United States spends far more on health care than any other nation, but our life expectancy has fallen behind 6 We must use the lessons of this crisis to better prepare for the next one and address the shortcomings in our health care system Patients can choose from a network that includes 93% of U S primary care physicians 7 Once adults are eligible for coverage, their age-specific mortality increases from the worst among 17 peer nations to one of the best (Figure 1) 8 The multiyear gap in life expectancy between Black and White patients who require dialysis disappears when both groups are covered by Medicare 9 Medicare also does a much better job of controlling costs compared with private health insurance: during the past decade, Medicare\'s cumulative increase in per-enrollee spending was 21 5%, far less than the 52 6% average increase among private insurers 10 FIGURE 1 A 2016 study found that in some U S medical practices, physicians spend as little as 26% of their time with patients 21 In contrast, family physicians in Canada spend 79% of their time on patient care,22 which could be one reason that more of them report being satisfied with their practices 17 In 2018, John Cullen, MD, then-president of the American Academy of Family Physicians, described U S medical practice as βan incredible bureaucratic mess to get anything done for patients β
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