Contact:
Jillian McKoy, jpmckoy@bu.edu
Michael Saunders, msaunder@bu.edu
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Marred by political constraints, most efforts to win affordable healthcare for all Americans have resulted in a patchwork of costly and often ineffective programs, not real health reform, says Dr. Alan Sager, professor of health law, policy & management at Boston University School of Public Health.
With healthcare spending expected to reach $5.6 trillion this year, the US pays twice as much per person as other rich democracies. Yet, Americans continue to suffer from inadequate insurance coverage and consistently high rates of preventable deaths and disability, infant and maternal mortality, and noncommunicable diseases.
The good news is that this lack of affordable and equitable healthcare is the “easiest problem to solve in the United States,” writes Dr. Sager in a new book.
In The Easiest, Sager argues that healthcare reform requires the US to contain costs safely, insure all Americans, secure the right doctors and hospitals where they are needed—with adequate pay—and address long-term and mental care, and affordable prescription drugs.
“The United States already spends enough money to deliver and pay for good healthcare for all 340 million people in this country,” he says. “The $5.6 trillion we spend on healthcare is six times the nation’s budget for defense. It’s triple education spending. One-half of health dollars goes to clinical and administrative waste, high prices for drugs and other items, and multiple forms of theft. We can win a victory for both competence and compassion with the money we already have.”
Still, political pressure for serious reform is almost invisible today, he argues in his book.
The first six chapters analyze the origins of the economic and healthcare crises and explain why fixing healthcare—not preventing illness or addressing social determinants—is the most effective strategy for reform. They delve into the four types of waste and their causes, and identify reasons for both market failure and government incompetence in healthcare.
Each of the 11 forthcoming chapters describes an important problem, analyzes its causes, and identifies ways to cover all people, contain costs, pay caregivers in trustworthy ways, organize delivery of care, boost the number of primary caregivers, sustain all needed hospitals, and lower drug prices while rewarding those who develop safe and effective new drugs.
The Easiest is a culmination of three years of work, informed by Dr. Sager’s 50 years of research and scholarship on local, state, and national healthcare problems and remedies.
He has published dozens of reports and studies on Massachusetts and US healthcare reform, affordable prescription care, and urban hospital closings, and has provided steady insight to media covering the 2024 financial collapse of the Steward healthcare system, the nation’s largest private for-profit hospital chain. The book is published exclusively online at www.healthreformprogram.info and is available to download for free (marginal cost pricing).
In the book, Dr. Sager identifies three massive problems that, within just a few years, may create pressure for healthcare reform that will be too intense to be ignored.
The first problem is a looming federal budget crisis, fueled by international tensions, reckless tax cuts, and the federal government’s yearly $2 trillion deficit. A resulting freeze in federal health spending would trigger a far deeper and broader catastrophe than those expected to arise from the Medicaid funding cuts in the 2025 budget resolution, as well as the pending expiration of enhanced ACA subsidies to buy insurance.
“If you’re one of the 10-20 million people who stand to lose Medicaid coverage or subsidized coverage from the ACA—or if you live or work in an area with a hospital closing—the crisis is here and now,” he notes. But far more Americans—almost all—will be affected by the broader budget crisis, he says. “A freeze in federal health spending would bankrupt many hospitals, disrupt doctors’ incomes, and deprive many more patients of financial coverage and actual medical care.”
It’s possible that this crisis will not occur—but it is critical to prepare in advance, he writes. He hopes that policymakers, healthcare and public health professionals, and the general public utilize his book as an “insurance policy” for this potential crisis.
“Beginning now to plan the responses to a crisis is vital,” says Dr. Sager. “It’s a complicated job that requires considerable time and testing of new methods. Otherwise, panicked responses to a freeze will tear healthcare apart, inflict vast harm on patients, and undermine the public’s confidence. We must be well-prepared to legislate, implement, and deliver the complicated and interwoven changes necessary to capture the trillions of dollars now wasted each year, and recycle them to cover all people, sustain all needed caregivers, and deliver medical security to all Americans. Once the plane’s engine stops, it’s too late to start sewing parachutes.”
This catastrophe of the federal financing freeze would be caused partly by healthcare’s own loss of legitimacy—the second problem—which he attributes to growing awareness of high healthcare costs and vast waste, increasing healthcare revenue year after year to finance business-as-usual, compromised access to care, caregiver shortages, and uneven quality.
The third looming problem, he writes, is the “anarchy” prevailing in U.S. healthcare.
“No one is accountable for containing cost, protecting access, getting the right caregivers in the right places, or boosting quality,” Dr. Sager says. “Anarchy stems partly from the absence of a competitive free market—because not one of its requirements can be satisfied in healthcare—and partly from decades of incompetent public actions. Reform first requires governments to make a few big, strategic decisions to cover everyone, cap spending, and pay needed caregivers well. Second, it requires paying doctors, hospitals, and other caregivers in ways that allow us to trust them—as professionals and fiduciaries and altruists—to take care of all of us well and to weed out waste and low-value care. Liberating doctors to make better decisions about how to diagnose and treat us can ensure good care while capping spending.”
“I hope this book inspires a new way of thinking about healthcare,” Dr. Sager says. “Reform should win medical security—confidence that, when ill or injured, we get effective, quick, competent, and kind care, without worrying about the bill. It will also contain spending on healthcare—which will liberate money to invest in housing, manufacturing and job training, family and community security, and all the other problems we need to address more vigorously.”
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About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.