Health care costs in the United States are grow faster than inflation, and the United States spends far more than other comparable countries on health care. And according to a health sector official, this situation is not sustainable.
“The health care system is bankrupt and failing us. This requires systemic reform, and it’s not going to come from inside the industry,” said Paul Markovich, president and CEO of Ascendiun, in a recent interview at the AHIP 2026 conference. Ascendiun is a nonprofit parent company of Blue Shield of California, Blue Shield Promise Health Plan, Altais and Stellarus.
This is why Markovich recently spear a national political reform movement called Worthy, which aims to present “compelling, but also pragmatic and non-partisan reforms,” he said. He shared four key policy efforts that Worthy promotes:
1. Digital health records: Markovich proposes to provide every American with a comprehensive, real-time digital health record capable of personalizing their care. He said it would save more than $300 billion in administrative costs across the system. Much of the healthcare system currently operates on outdated technology and fax machines.
“Technologically, it’s easy to do. It’s not complicated,” he said. “Everyone wants to make sure their information is secure and private, and we follow all applicable privacy and security laws and regulations. But all of this is achievable today. What’s difficult is that some commercial and financial interests are potentially at risk by making this information more widely available in a usable format.”
2. Change the way health care is paid: The healthcare industry needs to move to a payment-for-outcomes model rather than a fee-for-service model.
“Reward doctors, hospitals and everyone else for feeling better and improving your health outcomes, not just for doing more,” Markovich said. “Because when you reward all these players for doing more, they just do more, but it’s not necessarily better.”
3. Make prescription drugs affordable: The price of pharmaceutical drugs has increased to levels that are unsustainable for the public, Markovich said. He called for efforts to ensure that middlemen are not rewarded for selling a higher volume of more expensive drugs.
“[This] This is how it works today for pharmacy benefit managers [and] their affiliates like group purchasing organizations and specialty pharmacies, but this is also true for hospitals and doctors when they practice what is called spread pricing or billing, as with 340 billion for hospitals,” he said.
4. Set a budget for the health system: Markovich calls for budgeting health care organizations and imposing financial consequences for failing to meet budget targets. He argued that hospitals, in particular, are paid more to do more, which incentivizes them to do more tests, scans, keep patients overnight, etc. This ultimately leads to more inflation. Markovich instead proposes reimbursing hospitals a fixed amount on a monthly basis and adjusting it based on risk and population size.
“We’ll pay you more if and when your quality improves, and if you get good returns on your patients’ services, but basically there’s a high fixed cost to running this hospital. We’re going to pay for that whether people come to your facility or not, and so their incentive is to figure out how to serve a larger population without expanding. …I’m going to ask you to do what every average American family has to do, which is to make ends meet with a modest increase in your salary every year. It doesn’t seem like an unfair expectation,” he said.
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