My Thoughts on the US
Healthcare System
By Robert Duhaney, MD
As a primary care physician with over 16 years of experience, I have had the privilege of caring for patients from all walks of life. The U.S. healthcare system is vast, complex, and full of contradictions. On one hand, we have some of the most advanced medical technologies and brilliant minds in medicine. On the other, patients often face barriers to accessing even basic care. These barriers create frustration for patients and providers alike. As someone who works on the frontlines, I believe there are ways we can make things better—for both patients and those of us who have dedicated our lives to their care.
What’s Broken in Our System?
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Access to Care. While we tout the advancements of American medicine, millions of people still lack access to affordable healthcare. High deductibles, limited insurance networks, and lack of primary care infrastructure in rural and underserved areas mean that many patients delay or avoid seeking care until their conditions become emergencies.
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Administrative Burden. Primary care is supposed to be the cornerstone of healthcare, yet we are drowning in paperwork, prior authorizations, and electronic health record (EHR) inefficiencies. This not only reduces the time we can spend with patients but also contributes to burnout among providers.
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Fragmentation of Care. Our healthcare system often operates in silos. Patients see multiple specialists, undergo duplicate tests, and receive conflicting recommendations. As a primary care physician, my team and I spend significant time trying to coordinate care and ensure patients don’t fall through the cracks.
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Focus on Disease, Not Prevention. As Dr. Peter Attia says we need to move toward Healthcare 3.0. We're stuck in a 2.0 health system (1.0 was leeches and blood letting, now we have antibiotics and imaging). However, the 2.0 system is reactive rather than proactive. We are excellent at treating diseases but struggle to emphasize prevention and wellness. This imbalance leads to higher costs and poorer outcomes over time.
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Rising Costs. The cost of care—from medications to procedures to hospital stays—continues to climb. These expenses often leave patients feeling overwhelmed and powerless, even with insurance.​​​
A Vision for Improvement
So, what can be done? While systemic change is necessary, there are practical steps we can take to improve healthcare delivery—steps that empower both patients and providers.
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Strengthening Primary Care: Primary care should be the foundation of the healthcare system. More reimbursements goes to specialists and it should in many cases give the complexity of their work, but perhaps we in primary care could receive more for the role we place in coordinating our patient's care, answering their messages, and just being available. Increasing investments in primary care—from training more physicians, physician assistants, and nurse practitioners to improving reimbursement—would create a ripple effect of better outcomes and reduced costs. Patients who have strong relationships with their primary care providers tend to experience better overall health. Make the cost of the education lower and more tailored for real-world experiences by incorporating healthcare leadership and basic business aspects of healthcare.
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Streamlining Administrative Processes: Hospital/office/surgery center and other entity billing and coding alone is so complex that whole industries are set up around it very similar to the customer support industries in place just to complete a federal tax form. Simplifying prior authorizations, optimizing EHR systems, and reducing unnecessary documentation would allow providers to focus more on patient care. Technology should work for us, not against us. This is where Artificial Intelligence (AI) is already having an impact: from office note scribing to patient portal messages to assistance in generating diagnoses and treatment plans. I look forward to future progress in this area.
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Expanding Access: Expanding Medicaid in all states, having Medicare cover more anciallry servies like dental and vision care, increasing the availability of community health centers, and incentivizing medical providers to practice in underserved areas or with seniors as part of their training would help bridge the access gap. Telemedicine also offers tremendous potential to bring care to patients who might otherwise go without. We at One Medical are always working to balance in patient care with remote visits knowing the power of extension and convenience.
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Prioritizing Preventive Care: Incentivizing preventive services—such as age appropriate annual wellness exams (at One Medical we call these Live Well Visits) and getting recommended vaccines or cancer screening tests like PAP smears, mammograms and colonoscopies —can prevent disease and lead to early detection of diseases. This leads to healthier populations. Our goal is to educate patients on the importance of lifestyle changes, like healthy eating and exercise, and maintaining a healthy weight is equally vital.
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Focusing on Value-Based Care: Transitioning to value-based care models, where providers are rewarded for outcomes rather than the volume of services, could align incentives in ways that benefit both patients and the healthcare system. This has bee discussed for years but has been challenging to fully implement- one often overseen reason is because having the medical team fully on the hook (financial-rembursement-wise) for how healthy patients are is not entirely fair to the medical team as there are many issues outside the provider's control. So implementing a balanced apprach would be helpful.​
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Making Care More Affordable: Everyone agrees that the cost of healthcare is too high and it's not sustainable. There's no need to go to an urgent care/stand alone ER and have an X-ray of your shoulder only to have your insurance billed 3 months later for $5000. Or be told by your doctor that you could benefit from one of the new GLP1 meds to assist in losing weight and hopefully prevent getting diabetes and be told "sorry, that expensive monthly insurance policy that comes out of your check twice a month does not cover it.... so the retail cost to you will be $1000." What?! While this should never push anyone to the point of violence, we have to get common sense back here. Negotiating drug prices, capping out-of-pocket costs, and providing greater price transparency can help patients make informed decisions without fear of financial ruin. Mark Cuban's Cost Plus Drugs and Amazon Pharmacy are examples where this is starting to be done with some success.
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A Patient-Centered Approach
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At the heart of any healthcare system are the patients. One of the most rewarding aspects of being a primary care physician is building long-term relationships with patients and their families. When we center the system around their needs, rather than the demands of bureaucracy or profit, we create a healthcare environment that fosters trust, compassion, and better health outcomes. If the phsycian is happy, they are less likely to be burned out and more likely to be engaged in the patient's health success. It’s not just about treating illness; it’s about understanding the person sitting across from us in the exam room or Zoom screen. Listening to their concerns, validating their experiences, and empowering them with the tools to take charge of their health are what make primary care so impactful. I like it when people come in with various ideas form outside sources- instead of ridiculing patients, we can provide perspective in a repsectful way.
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Moving Forward
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Change in healthcare will not happen overnight. It requires collaboration between policymakers, healthcare providers, insurers, and patients. Yes, many of the items listed above will literally take Acts from the US Congress to change. But I remain hopeful. Every day in my practice, I see the resilience of the human spirit and the power of compassionate care. By addressing the systemic flaws and doubling down on the doctor-patient relationship, we can create a healthcare system that truly serves its purpose—healing and caring for people. As we move forward, let’s remember that healthcare is not just a system; it’s a partnership. Together, we can make it better.
