None of the Current Healthcare “Solutions” are Viable.  What is?

Reasons why all the current solutions are bad and what and how we can do better, faster and cheaper

Introduction

Today we are going to discuss all the ways the world finances healthcare, why none of them are viable, and how we can fix this situation.

The Situation

There are five ways currently to finance healthcare

Current Solution: Big Insurance

We all know the problems with big insurance. Last year, Americans paid approximately $5.3 trillion for healthcare.  What did that really buy them though?

UnitedHealthcare projects $337 billion in 2026 revenue. Of that, $164 billion flows through "eliminations" to their Optum subsidiary—internal transfers they count as medical costs to hit the 80% MLR threshold. Add operating earnings of $17.5 billion, and their total profit is $181.5 billion—a 53.86% margin.

And that's not counting what the insurer forces your doctor to pay. Administrative costs for billing, coding, collections, dealing with denials and delays; 10% to 25% of revenue just to get paid.

The math: You pay $100. UnitedHealthcare keeps $54. Your doctor spends $10-$25 fighting to get paid. You get $21-$36 worth of care for your Benjamin.

This is not viable.

Government Sponsored/Nationalized Healthcare

Most of the developed world has some form of nationalized health insurance AND nationalized industries and high taxes to pay for it. It doesn’t work.

Canada

Their own government admits the health care system is "under significant strain," with 250+ ER closures in 2025 and doctors leaving.

The Cost

Nationalized auto industry (Ontario) needed bailouts.

UK

NHS waiting list stands at 7.29 million people. Over 1.57 million patients waited more than 4 hours in A&E.

The Cost

Nationalized industries from British Leyland cars to British Steel have collapsed.

Netherlands

Wait times exceed targets—13 weeks for gastroenterology. Access to innovative medicines averages 459 days.
The Cost

Shell and Philips are retreating from Dutch ownership.

Denmark

Average wait for hospital treatment is 38 days—but at the cost of 66% tax rate.  
The Cost

Maersk stays afloat only through global trade, not nationalization.

Finland

44% of patients wait more than a week.   
The Cost

Finland's top marginal rate is 52%—even higher than Germany's 45%. That's 41% higher taxes than the US. Nokia was nationalized then privatized; it only survived by selling to Microsoft.

Germany

Bismark works wonderfully, I’m told. 
The Cost

Effective tax rate of 66%—but still has nationalized Volkswagen (part-owned by government), Deutsche Telekom, Deutsche Post. Zose "vonderful carss" ze Germanss build? The average German family can't afford one.

The pattern is clear: higher taxes AND limited access to care AND failing nationalized industries. You can’t do any of that in the US.

This is not viable.

Direct Primary Care

Direct Primary Care  (DPC) sounds simple: cut out the insurance middleman, charge patients a monthly fee, and practice medicine. The problem? The math doesn't work.

DPC doctors claim you can save $10,000-$20,000 annually, but add a catastrophic plan for emergencies—that's another $5,000/year. Your total: DPC fee ($1,500) + catastrophic ($5,000) = $6,500 out of pocket, plus you still face a $5,000-10,000 deductible before catastrophic kicks in.

Compare that to a traditional PPO: average deductible is $1,787 with a max out-of-pocket around $9,200.  There is a reason employers don’t fall for this.   You're better off with traditional insurance.  The doctor gets paid more to do less, but you are better off with traditional insurance.

DPC is not a replacement for even traditional insurance.

This is not viable.

Cash Pay/Health Savings Accounts

Here's the pitch: skip the insurance middleman, pay cash, save money. Sounds simple. The problem? It only works if you're already rich.

Cash-pay models remain concentrated in markets where patients have the liquidity to self-pay. In working-class areas? The model collapses because patients can't afford $150-300/month out of pocket. Meanwhile, DPC practices grew 83% between 2018-2023—but still represent a tiny fraction of primary care delivery.

And HSAs? They're not savings—they're spend accounts in name only. Only 10% of employees funded an HSA last year. The rest? 54% say their financial state impacts ability to save for retirement—and 25% can't afford prescriptions.

Here's the kicker: you need a High Deductible Health Plan (HDHP) to qualify for an HSA; that's a $1,650+ deductible before you can use it. You're paying for expensive insurance, then paying again out of pocket. The HSA is just a tax-advantaged way to watch your money disappear.

The cash-pay trend is accelerating—but it's built on the backs of people who can afford $3,600/year in cash, and who wait to get sick until they have enough to afford the cure. For everyone else? You're still stuck with traditional insurance—and now with fewer doctors accepting it.

This is not viable

Health Shares

Here's the pitch: join a healthshare ministry, share your money with other believers, get your medical bills paid. It's not insurance, it's community. The problem? It's not insurance by design, so they don't have to pay.

Health shares are not insurance. They're legal loopholes carved into the ACA, because they technically aren't insurance, they don't have to cover anything. 194 consumer complaints have been filed against healthcare sharing ministries since 2020.

And they deny claims freely. Pre-existing conditions? Not covered, for the first 36 months. That chest pain you have had for years? Mitral valve prolapse, even if your doctor disputes it, denied as pre-existing. They are not obligated to pay anything.

There is no guarantee. Unlike real insurance, which is regulated and must pay claims, healthshares operate on honor, "we will share your bills if we feel like it." One member told investigators "I am relying on prayer" because her claims were denied.

Wait, it gets worse. Many healthshares do not even count member contributions as revenue. They are held in "member sharing accounts" that do not appear in audits. There is no financial oversight. No reserves. No accountability.

The monthly cost looks appealing. But you are betting your health on a theological argument. When you need a $50,000 surgery, you will find out quickly whether "sharing" means "paying."

“But it is non-profit” I hear you thinking very loudly.  Yeah?  So is BCBS, the “B” in “BUCAH.”

Health shares are not viable.

The Logical Conclusion

Healthcare collapses under its own weight:

There is nothing viable on the market today.  Healthcare will either collapse or it wil large the economy down with it or it will find a novel solution that includes streamlining and automating the entire healthcare finance industry.

The Short Answer

Automate health insurance; get rid of everything that isn’t “pay for your care.”  That saves the patient about half because they don’t pay for all the profits and hurdles the big insurers put in their way.  Automating health insurance saves the hospital and practice about a quarter and for the same reasons.  They don’t have to deal with trying to wrestle payments for services already rendered.

Sentia has this solution in production right now.  

We provide the practice and hospital the data-driven Electronic Medical Record (EMR) and detect and pay for procedures documented in real time.

The Slightly Longer Answer

The Data-Driven EMR

Universal Medical Language System

The first order of business to streamline and automate these processes is to find a universal nomenclature, a set of concepts that is adequate to document the entire medical process.  The National Institutes of Health (NIH) provides the Universal Medical Language System (UMLS) that is adequate for this task.  That is what Sentia’s EMR is based on.

Solving the General Problem

Since we have a universal data source, we can then produce a universal medical records system.  Let’s look at this a different way.  If you pulled your F150 into the dealer’s service drive and noticed that they had an engine documentation system and a transmission documentation system and an electronics documentation system and a suspension documentation system, ad nauseum, you would shout "that's dumb” and go buy a Chevy, and rightly so.

Why then do we put up with 130+ versions of an EMR one for each specialty?  “That’s dumb.”  At Sentia, we believe in solving the general problem.  When asked to write a medical scheduling system, we didn’t do that.  We wrote a system that could schedule WhiteSnake at Reunion Arena in 1987.  We programmatically and in a data driven fashion described the stage, the room, all the seats, all the jobs and who would perform the.  We solved the general problem.  Putting a Doctor, a CRNA, a colonoscope and a patient all in the same room at the same time then, became trivial.  

If you need to book WhiteSnake at Reunion Arena in 1987, call me, I can’t make you such a deal.

Integrating Coverage

Now that we have a data-driven EMR, we can pluck procedures performed out of the database and pay for them in real time.  Not five minutes, not a week, not a month, not 180 days.  Right now.

That completely automates the healthcare finance system.  The whole thing.  

Automated Health and Wellness

Also since we have data, we can compare measurements and lab results to averages and determine a patient’s level of health.  To incentivize improving that health we offer a 15% discount on coverage.  Sentia provides all patients with health education materials based on their out of range measurement and lab results.  When the patient follows the education and improves his or her measurements and lab results, he or she gets a 15% discount on coverage  

Enterprise Resource Management (ERP) Style Practice/Hospital Management

Part of the cost problem is that no hospital knows how much it is making.  They don’t have the first clue how much a procedure costs to perform.  They just have to wait until the end of the month to see if they have any money left over to call profit.

Sentia provides an Enterprise Resource Planning (ERP) style Practice and Hospital Management System (PHMS) that accounts for every financial transaction that occurs in the enterprise. The makes it possible to run a Profit and Loss (P&L) statement on every facet of the enterprise.  You could run a P&L on any employee, room, procedure, consumable, piece of equipment, wing, floor or the entire enterprise, allowing administration to find cash leaks easily and quickly and most importantly without a team of expensive accountants holed up in a conference room typing into excel for months.

Included with the PHMS is a work queueing system.  This allows the work to be assigned to the workers instead of the workers assigned to the work.  Let’s illustrate.  Normally a nurse is assigned to four rooms and is responsible for everything that happens in them.  There is always a nurse charting or gossiping at the nurses station,  while someone else is working his or her fingers to the bone trying to keep up. The first nurse is a misallocation of resources.  The second nurse lets things fall through the cracks and misses steps altogether and jeopardizes lives.  

A better way sould be to aggregate all the rooms withing the ward/floor/wing and have all the nurses work on all the patients.  The oldest/most urgent task gets automatically assigned to the longest idle nurse.  

That way, we don’t have misallocation of resources, and we don’t have nurses “in the weeds” jeopardizing people’s lives with missed tasks.  This also accounts for the one off tasks that take hours or a shift.  Several months ago my mother was in the hospital.  They needed to do an MRI but couldn't perform it until they had the information on one of her implanted devices. Her stay was eight days.  Her nurse needed several hours to sit down and do the research on the device and figure out how to turn it off and simply could not find the time.  This queueing system could have turned that stay into half a day , freeing resources for more acute cases.    

Coverage Delivery Methods

“Gee that sounds great, but how do you tie the bell on that cat?”  You were thinking loudly again.  

Sentia as the Coverage Company

Sentia provides the coverage either through direct sales, group plans or on healthcare.gov

Sentia as TPA/Captive

Sentia provides health plan administration as a third party administrator or captive insurance company.  We provide the policies and coverage and present the employer with an itemized bill at the end of the month for services rendered to employees  

Sentia as Direct Universal Care (DUC) Facilitator

The real hero in this system is the software.  This is how we achieve the streamlining and automation of processes.  To that end we will provide your local hospital(s) with the software for a small data management fee.  They can then partner with specialty and primary care practices in the community and even Ambulatory Surgical Centers (ASCs)  to provide all the healthcare a patient will ever need.

For procedures and care not offered locally we can partner with nearby hospitals to provide the rest at a pre-arranged rate.

The patient pays the hospital directly for the coverage, eliminating the big payers and their wasteful processes altogether.

All three of these delivery methods are the same cost and will save patients half. Practices and hospitals also using this suite will save an additional quarter through not only streamlining their own processes, but by not having to deal with the big insurance companies.

Cost

The cost is very simple.  It is $10 per month plus the actual cost of the risk.  

The Risk

The calculation of the risk is fairly straight forward.  Take the incidence of occurrence in the population, multiply by the cost, divide by the number in the population, and then again by 12 to get a monthly premium.  

For example:  228 people are going to need an appendectomy in the coming year in a population of 100,000.  The average open appendectomy costs about $5,000.

228 * $5000 = $1,140,000

$1,140,000 /100,000 = $11.14

$11.14 / 12 = $0.95 per month for everyone in the population.

That is not a bad price to be covered against an appendectomy.  

Sentia does this calculation for every covered procedure, everything the patient will need, and totals it up for the total risk calculation.

The Management Fee

For the privilege of maintaining your coverage data, Sentia Charges $10 per month.  This is lieu of everything your legacy insurance company does.  WE automated that entire process and charge $10 per month instead of half your premium.

Conclusions

We have shown a way to regulate every financial transaction a practice or a hospital enters into, the Practice/Hospital Management System (PHM).  Included with the PHM is a workflow elimination tool that extracts more and better work from employees and streamlines and automates every facet of patient care.  All that increases revenue and decreases costs by about a quarter.

We have shown a way to incentivize healthy living in a population and decrease chronic disease and therefore decrease costs for us all in a streamlined and automated manner.  This alone has the potential to save $1.34 trillion or about 25% of healthcare spending in the US

We have shown a way to revolutionize the way medical records are thought of, executed, used and searched.  This eliminates Epic, all the legacy EMR vendors and makes research a simple pick and click operation, saving millions of lives.

We have shown a way to integrate health coverage into the EMR.  The practice or hospital gets paid as the practitioner documents patient care.  That eliminates medical coding, verification, adjudication, pre-authorization, denials, delays, insurance networks, rate negotiations, sales/brokers/agents, money for a third-party EMR, skyscrapers in every major city, hundreds of thousands of employees, all the insurance monkey business and reduces cost by about half. 

It also eliminates Epic/Cerner AND the legacy insurers.

It also makes your facility leaner faster, more efficient and more profitable.

We have shown three viable adoption plans to move toward lower cost healthcare in the United States. These plans cut more than half from the cost of health coverage and eliminate the big payers and the legacy EMR vendors in one fell swoop.  Over time we will eliminate about half the remaining costs as patients get healthier.  That means a 75% reduction in costs overall.

We have built a comprehensive health information system to keep the patient healthy and on the right track with the ability to incentivize healthy living. This system includes the automation of the health insurance industry completely, eliminating more than half the costs by Sentia as the coverage company, employer based captive or TPA or by direct payments to doctors and practices.

Here are additional points detailing the costs incurred by the legacy insurance companies that you pay currently, in addition to wasting about half your premium, according to Grand View Research and current as of 2023 and that Sentia would eliminate completely:

Medical Records:

• The average practitioner spends $35,925 annually on electronic medical records
• The average patient spends $106 annually on electronic medical records
• The average patient encounter or visit cost for electronic medical records alone is $32

Medical Coding:

• The average practitioner spends $20,286 annually on medical coding
• The average patient spends $60 annually on medical coding
• The average patient encounter or visit cost for medical coding alone is $18

Compliance and Efficacy Reporting:

• The average practitioner spends $17,165 annually on compliance and efficacy reporting
• The average patient spends $51 annually on compliance and efficacy reporting
• The average patient encounter or visit cost for compliance and efficacy reporting alone is $15

Totals:

• The average practitioner spends $73,376 annually on completely avoidable costs
• The average patient spends $217 annually on completely avoidable costs
• The average patient encounter or visit cost for completely avoidable costs alone is $66

Yes, you read that correctly: $66 per visit. That is probably more than the practice makes on the average encounter.  There must be a better way. There is a better way and Sentia has it.

Remember also that these costs are over and above the 50%+ your insurance company wastes or shoves into their pockets.

We have designed and are building an ERP style practice/hospital management system that will pinpoint and eliminate cash leaks and inefficiencies in enterprise medical facilities. Implementing this system should be fairly simple and will completely revolutionize the way healthcare is delivered and paid for, saving countless lives. We have shown a way to use this system to make the best healthcare system in the world also the most efficacious and the most affordable.

If you liked what you read contact us here, on our site, SentiaHealth.com, our parent company SentiaSystems.com, or send us an email to info@sentiasystems.com or info@sentiahealth.com.