This past week, I had the privilege of speaking to pre-med students, graduate students, and faculty in the medical sciences at the University of Notre Dame. My topic was “How We Die in America: Fear, Faith, and the Moral Limits of Medicine." Over the last several generations, dying in America has changed dramatically. What was once primarily a spiritual and family-centered event has evolved into a medical technology event. This lecture focused on dying in America and healthcare's role in...

America’s healthcare crisis is not caused by one bad policy or one failing program. The system is breaking because it is built on incentives that undermine affordability, coordination, and quality. When you look across the major failures — rising costs, fragmented care, clinician burnout, unnecessary utilization, fraud, and overwhelming administrative burden — a single pattern emerges: these are symptoms of a fundamental design flaw. Affordability Is the Breaking Point ACA premiums keep...

In U.S. healthcare, payor mix and service mix—not posted “prices”—determine whether hospitals and physicians stay financially viable. Payor Mix: The Real Driver Different insurers pay providers wildly different margins: Medicare: ~90% of costs (negative margin) Medicaid: ~70% of costs (even more negative) Uninsured: ~25% of costs (catastrophically negative) If a provider relied solely on these groups, it would go out of business. Because prices cannot be negotiated with government...