As of January 1, 2026, the American health care system is in crisis. People can no longer afford their health insurance premiums or even to afford to pay for any health insurance. Recently, a 62-year-old self-employed friend of mine saw his premiums increased tenfold in a single cycle. I am lucky that I am over 65 and have Medicare insurance as well as a pension from my employment. Millions of people from all walks of life, from all political persuasions, from every income level except for the ultra-rich, are affected. This health care funding crisis threatens individuals and families as well as federal, state, and local budgets.

Until this week, it appeared that funding health care would be at the top of the agenda at the House of Representatives and the Senate. Recent local, national, and global events suggest that this is no longer the case. Still, we need a less bureaucratic system that is responsive to individual patient needs, the needs of health care providers, and is affordable for taxpayers, individuals, and families. As Kevin has often reported in KevinMD blogs, there are over 80 million Americans with no primary care provider (PCP: physician, physician assistant, or nurse practitioner).

My nurse practitioner spent less than 20 minutes with me in my initial intake appointment. My nurse practitioner PCP probably has responsibility over health care for more than 2,000 patients. A reasonable patient panel for a PCP should be 600 to 800 patients in my opinion. Being a primary care provider should no longer be a relatively low-wage recipe for burnout.

After my low back became unstable over two years, I had very successful low back stabilizing surgery. After a few months, I could swim a mile, dance in 50-minute Zumba classes, do daily 20-minute hatha yoga online classes, and participate in weekly 25 to 50-mile group bike hikes.

Almost a year ago, I had to cut back on my sports activities because of my back. Ordered an appointment to a physical therapist, which was not scheduled until three months later. When my appointment finally came, the physical therapy secretary scheduled me for 10 weekly appointments before I even saw the physical therapist. After two appointments, I quit because it wasn’t working. Soon thereafter, two friends, without backgrounds in health care, showed me their elastic resistance bands to strengthen core abdominal muscles. They worked! There is something wrong with this health care business model.

Despite my efforts over the past 28 years, the health care business has successfully monetized anticoagulants for treatment and prevention of clots and drugs for mild hypertension. Pharmaceutical companies brought together and funded clinical trial researchers, medical journal writers, editors, and complicit Food and Drug Administration regulators. This has resulted in deaths from bleeding and falls for hundreds of thousands of people worldwide. A study from Yale University has a similar finding about the risk of falls and leg fractures due to blood pressure-lowering medications.

We now have a once-in-a-generation chance to do something about both the quality and cost of American health care.

The structural solution

Accountable Care Cooperatives (ACCs) could provide a workable alternative to our current system. By transitioning from capitalist fee-for-service models to community-owned ACCs, competing to best provide excellent health care while controlling costs, the federal government can stabilize the national deficit by freezing health expenditures at FY2026 levels while simultaneously expanding coverage to all U.S. residents.

Key pillars of reforming U.S. health care

• Community governance: Approximately 3,000 to 5,000 ACCs are private, nonprofit, member-owned entities certified by independent panels of administrators from regional ACCs.
• Fixed fiscal responsibility: Federal, state, and local government outlays should not exceed FY2026 levels through 2035.
• Elimination of waste: By removing many unnecessary fee-for-service administrators, ACCs will reduce nonclinical overhead.
• Integrated social care: For food and housing insecure people, ACCs may reinvest savings into housing and nutrition.

Nutritional and vocational transition

In alignment with the Healthy SNAP Act (Supplemental Nutrition Assistance Program) of 2025, ACC funds will be prohibited from purchasing sugar-sweetened beverages or ultra-processed foods. Instead, ACCs would assume local administration of federal nutrition programs to address the root causes of metabolic disease.

Employees of the legacy insurance industry would be the first hired for ACC administrative roles. For low-income families, ACCs would provide college tuition at accredited public institutions.

Transparency and accountability

To ensure trust, every ACC must periodically report member clinical outcomes, administrative spending, and member satisfaction.

Comparison table: Current system versus ACC model

• Payer system: Current system (2026): Fragmented private/public. ACC proposal: ~3,000 to 5,000 community-owned ACC payers.
• Admin costs: Current system (2026): 30 percent to 34 percent. ACC proposal: No more than 10 percent.
• Nutrition policy: Current system (2026): HHS subsidized ultra-processed foods and sugary drinks. ACC proposal: Metabolic health/whole food focus.
• Social integration: Current system (2026): Siloed programs (housing/education/employment). ACC proposal: Integrated “social care” strategies.
• Transparency: Current system (2026): Proprietary/closed data. ACC proposal: Periodic public disclosures.

David K. Cundiff is a physician, author, and health care reform advocate whose work centers on transforming the U.S. health care system and addressing broader societal challenges, including climate change. He is the author of Grand Bargains: Fixing Health Care and the Economy, which proposes structural reforms to dramatically reduce health care costs while improving outcomes. His essay “Much Better Healthcare for Way Less Cost” explores accountable care cooperatives and community-based reform. Additional works include Money Driven Medicine – Tests and Treatments That Don’t Work and Whistleblower Doctor: The Politics and Economics of Pain and Dying.

From 1981 to 1998, Dr. Cundiff practiced, taught, and conducted clinical research in internal medicine and pain control at the Los Angeles County + USC Medical Center, where he directed the Cancer and AIDS Pain Service for nine years, and previously held an academic affiliation with Harbor-UCLA Medical Center. After exposing how systemic inefficiencies increased hospital utilization and revenue, he became a whistleblower, an experience documented in Whistleblower Doctor.

Outside his professional work, Dr. Cundiff values time with friends and family, including six grandchildren, and maintains his health through Hatha yoga, meditation, swimming, Zumba, biking, and a diet emphasizing minimally processed organic food.