Take Control — Bringing American healthcare into the light

Bringing American healthcare into the light

Take Control

We spend more for healthcare than anyone in the world,
but we're clearly not getting what we paid for.

The problem

Great medicine, broken system.

American medicine at its best is the envy of the world. Our cancer survival rates are among the highest anywhere, and when your life is on the line, people cross oceans to be treated here.

The failure is not talent or effort. We are extraordinary at rescuing people and remarkably bad at seeing trouble coming, because no one can see the whole picture. And it shows up as three crises.

Cancer survival: CONCORD-3, The Lancet

You can't fix
what you can't see.

Crisis one · Health

We are living shorter lives,
and falling further behind.
Every year.

Life expectancy at birth, 1980 to 2024.

The United States against comparable peer nations

In 1980 we were less than a year apart. America has lost ground nearly every year since.

Source: Peterson-KFF Health System Tracker, analysis of OECD data. Axis begins at 72 years.

43%up from 6%

Rural America is losing ground fastest.A working-age adult in rural America is 43% more likely to die of natural causes than one in a city. Twenty years ago the difference was just 6%. Rural death rates rose while urban rates fell. USDA ERS

COVID2020-2023

The pandemic widened the gap.America's mortality gap with peer nations grew further through COVID, when other countries could see their outbreaks and we could not. Peterson-KFF

A pregnant woman resting her hands on her belly.

Nowhere is the failure starker than for mothers.

America's maternal death rate is the highest of any peer nation, more than 80% of those deaths are likely preventable, and in rural America the rate nearly doubles again. A pregnancy missing prenatal care should never become a statistic to mourn.

Sources: Commonwealth Fund · AJPH

Add it all up, and we finish last.

Nine peer nations were measured on access, equity, administrative efficiency, care process and outcomes. Here is where America landed.

Last of ten. And not even close.

Overall health system performance, 10 peer nations

Nine peers cluster together. One country sits far behind the rest.

Source: Commonwealth Fund, Mirror Mirror 2024. Positions follow Exhibit 2; scores are standardized, so the axis carries no numeric ticks.

Crisis two · Cost

Americans spend far more than anyone.

We pay double what others pay.

Health spending per person, 2024 · United States vs. comparable peer nations

Comparable countries: Australia, Austria, Belgium, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the U.K.

Sources: CMS · Peterson-KFF

And we get less care for the money.

Care received in the United States vs. comparable peer nations

The money is not buying more care.
We simply pay more because of administrative costs, waste, fraud and abuse.

Source: Peterson-KFF Health System Tracker, OECD Health Statistics · administrative costs and waste: JAMA, 2019. Peer stay average includes Japan; 7.4 days excluding it.

41%of U.S. adults

Carry debt from medical or dental bills. KFF

1 in 2of U.S. adults

Could not cover an unexpected $500 medical bill. KFF

►

CBS News

Report finds U.S. health system ranks last, despite paying more

On the outcomes gap

►

CNBC

Why Americans Have So Much Medical Debt

On medical debt

The case for clear data

$5,000or more, every year

If American healthcare ran as efficiently as other developed nations, every American would save $5,000 or more. Every year.

Crisis three · Security

Our broken system has become a national security threat.

We are a country that cannot see its own outbreaks. When an outbreak starts in Denmark, it surfaces in the national health data almost immediately, and the government can find and reach the patients at risk. America tracks flu season by asking a few thousand volunteer practices to send in weekly reports. Often by fax.

If a new threat emerged tomorrow, natural or engineered, we would have no way to identify or contact the Americans it endangers. And in an age of cyber and biological warfare, when engineering a new threat is easier than it has ever been, a system that cannot see its own outbreaks is more than a healthcare failure. It is a national security exposure. COVID previewed the cost.

Sources: CDC FluView · Peterson-KFF

When we could not see it, more of us died.

Confirmed COVID-19 deaths, and the share of each population lost

Population size explains only part of the gap. An American was more than six times as likely to die of COVID as a person in Japan.

Source: Our World in Data, confirmed deaths as of August 2026

One root cause

A $5.3 trillion system
depending on silos that never talk.

Every visit, test and prescription creates a record. But your labs live in one building's computer, your specialist's notes in another, behind a different login for every doctor. Your record is not one record. It is in hundreds of pieces.

Unlike nearly every other developed nation, America has no national health database, no way for you to see your own complete record, and no real informed patient choice.

Only a sliver of American healthcare can be studied.

Share of the population whose claims data can be systematically analyzed

Traditional Medicare — 10%

Claims can be analyzed for cost, care and outcomes.

Everyone else — 90%

Medicare Advantage, Medicaid, employer plans, ACA and self-pay, scattered and out of view.

Source: CMS, coverage and claims-data availability

The solution

America's Health Trust.

It begins with one fix we never tried.

Turn thousands of incompatible ledgers into one honest set of books, managed and controlled by a new player: us.

From scattered pieces to one clear picture.

The records all exist today. They have simply never been brought together.

A national all-payer claims database, coordinated with existing state systems

Three things the Trust is not.

Not government-run healthcare.

Not eliminating private insurance.

Not rationing care.

America's Health Trust is a modern system of accountability. Designed to improve health, at lower cost, across the board.

How it works

Three steps to put us in control.

One national record

A secure national database, administered by Medicare, joining the claims Medicare already holds with those from commercial insurers, employer plans, Medicare Advantage, and Medicaid. One common format, with a common goal: America's health.

Your record, any time you need it

One lifetime medical history for every person, from first checkup on, that you can see 24/7. No more faxing records. No more starting from scratch with every new doctor, insurer, or state. And state-of-the-art security under HIPAA to ensure privacy, with every American free to opt out at any time.

Informed patient choice

An open, transparent system. See what care really costs, how well a treatment really works for patients like you, and what the risks really are, before you say yes.

12-18months

We can start fixing this right now.

We can get moving within the first 12 to 18 months of reform, using data insurers already hold.

Why hasn't this happened already?

We spent 20 years building the wrong thing.

Since 2009, Washington has poured roughly $30 billion into digitizing and connecting America's medical records. The records got digitized. They never got connected.

With one national record of claims, we create infrastructure that never existed: as basic as any road or bridge. We talk constantly about building highways. It is time to build the pathway to a longer, healthier life.

Source: U.S. Government Accountability Office

The outcomes · Discovery

The cure is in the data.

Today, researchers can systematically study only the small share of Americans in traditional Medicare; everyone else's care sits scattered across more than a thousand insurers. Connect it, and medicine gets a laboratory the size of the country: which treatment works best for someone like you, which drug is quietly failing, which protocol saves lives. Dangerous side effects would surface in weeks instead of years.

It took five years to catch Vioxx.

Rofecoxib (Vioxx), a bestselling prescription painkiller, 1999 to 2004

5 years

on the market while the evidence of its heart-attack risk sat in pieces, scattered across separate insurers' systems where no one could read it whole

88,000+

estimated excess heart attacks and sudden cardiac deaths in the US before it was withdrawn. The study's estimate runs as high as 140,000

1 insurer

supplied the claims data that finally exposed it: 1.4 million patients at a single California health plan. That is what one connected slice of the data could do

The signal was in the claims data the whole time. Nobody could see it.

Source: Graham et al., The Lancet, 2005, an analysis of Kaiser Permanente claims · withdrawn September 2004

Your record

Your record, in your hands.

Today your medical history is not one story. It is a pile of fragments, each one held by whoever happened to be treating you at the time.

Today

Every time your life changes, the record starts over. A new job brings a new insurer. A new insurer brings a new network. A move across a state line brings a new set of doctors who know nothing about you. Your history does not follow you. You carry it.

So you fill out the same form again. You try to remember the antibiotic that gave you a rash six years ago, the year of the surgery, the dose you settled on. You ask one office to fax something to another. Things get left out, because no one remembers their own medical history perfectly. No one should have to.

With one record

One lifetime record ends that. Your labs, your prescriptions, your history, in one place you can open at any hour of any day. The specialist you have never met reads it before you sit down. The emergency room treating you unconscious knows what you take and what you are allergic to. No faxing. No repeating a test you already had and already paid for.

And you are the one in control of it. You decide who sees it. You can read every entry in it yourself. You can opt out at any time, and that choice changes nothing about the care you receive.

The record you need most in an emergency should never be the one that keeps starting over.

Cost

See the price. End the waste.

As much as a third of what America spends on healthcare is waste, fraud, and abuse. Even conservative peer-reviewed estimates put the floor at $760 to $935 billion a year, and most of it goes uncaught because no single insurer ever sees a provider's whole pattern.

Connect the data through America's Health Trust, and those patterns light up. Duplicate billing. Services that never happened. Prices that vary by hundreds of percent for the same procedure across town.

Put prices in the open and providers compete on cost and quality instead of confusion. That is money returning to families, employers and taxpayers rather than disappearing into the gaps between systems.

A third of your bill is not care.

Annual health spending per American, and the share a connected system could return

Spending: CMS, 2024 · waste floor of $760-935B a year: JAMA, 2019 · $5,000/yr is this proposal's projection

Security

A country that can see itself.

America watches for outbreaks by asking a few thousand volunteer practices to fax in reports once a week. Peer nations see theirs in the national data almost immediately, and can reach the people most at risk.

When every claim flows into one secure national picture, an outbreak shows up as it starts rather than weeks later. Public health can find the patients who are most vulnerable and reach them while it still matters. In an era when biological threats are getting easier to create, that is not a healthcare nicety. It is the difference between responding early, or finding out when it is too late.

How long before anyone knows.

Time from care happening to public health being able to see it

A week is a long time in an outbreak.

Source: CDC FluView, ILINet reports weekly from about 3,000 volunteer outpatient practices

The takeaway

What does taking control mean?

Longerhealthier lives, with care decisions built on real information

Fasteraccess to care, with less paperwork between you and your doctor

$5,000a year back in your pocket, as waste, fraud and abuse get found and stopped

In chargeof your own record, your own data, your own choices

$5,000/yr is this proposal's projection · waste floor: JAMA

Healthcare is not left or right.It is American.

Transparency, lower costs, and better care. Our common ground.

America's Health Trust. It's time to take control.

Take control.

This is how we build a healthcare system that finally works for the people who depend on it. If that is a future you would like to help build, we would love to keep you close.

Thank you. We will be in touch.

Occasional updates on the effort. Nothing more.

Sources

Every figure on this page.

Drawn from public data and peer-reviewed research, presented for informational purposes so anyone can check the work.