According to Robert Smith, Executive Director of the Colorado Business Group on Health, “The
one thing we know about health (in the US) is that it is driven by economic self-interest”. Focus
on economic self-interest leads to multiple negative ramifications. A 2021 report by The
Commonwealth Fund, the Organization for Economic Development and Cooperation, and the
World Health Organization, measured “access to care,” “care process,” “administrative

efficiency,” “equity,” and “health care outcomes” in eleven wealthy nations. The analysis ranked
the US dead last in all categories except for “care process.” (Mirror, Mirror 2021: Reflecting
Poorly: https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly)

What’s going on? Why is US health care delivery so out of line with that of other developed
nations? Economic incentives appear to be at the root of the problem. Patients, providers, and
payers motivated by self-interest often work at cross-purposes with each other. Providers want
to gain as much market share and revenue as possible. Payers attempt to minimize payouts to
providers. Third-party insurance coverage exacerbates the problem by masking true cost. The
patient often has no clue and providers have few incentives to contain it. Ultimately, patients
must navigate through a complex and confusing bureaucratic maze and struggle to understand
and secure affordable health care. There are many who have no third- party coverage.

What’s to be done? Can substantial reform occur without developing universal health coverage
and going up against the entrenched interests of big pharma and health insurance companies?
Perhaps the underpinnings for realistic reform already exist in Wisconsin. The state is home to
several organizations like the national trade association for credit unions (CUNA Mutual), multi-
specialty and group physician practices, and the community-owned and funded (and
extraordinarily revered) Green Bay Packers. Parts of these various models might form the basis
for an organization to reform health care delivery, be member owned and governed, market
based, and not government financed or operated. Possibly, Wisconsin could lead the way to not
only statewide reform, but also national.

Your challenge is to come up with an innovative plan to improve an aspect of our healthcare
delivery system that you believe needs significant reform without completely undermining
existing stakeholders. To do so, you must identify a specific problem, research and analyze its
various components, and propose innovative solutions to improve it. As you develop your
project, be sure to communicate with several interested parties so you can incorporate their
insights into your thinking.

As Catalyst 300 students, are you willing to take on this challenge? It will not be easy. There will
be unforeseen pitfalls and risks, but also substantial benefits. The potential is enormous. Are
you up for it?