Fixing Healthcare Won’t Be Enough

Why healthcare doesn’t need repair. It needs reimagination.

By Donna M. Bergman

Published October 19, 2026

Healthcare leaders often talk about fixing healthcare. But what if the real challenge isn't repair? What if today's healthcare system was designed for a different era and requires reimagination rather than optimization? This article explores healthcare transformation, consumer expectations, value-based care, and the opportunity to redesign healthcare for the realities of today.

Every conference. Every panel discussion. Every strategic plan. Someone inevitably says:

"We have to fix healthcare."

I disagree. Not because healthcare doesn't have problems, but because the language itself reveals a flawed assumption:

To fix something implies it once worked.

Healthcare does not need to be “fixed.” It needs to be reimagined and rebuilt for today’s needs, expectations, and capabilities.

Why Fixing Isn’t Enough

Language matters. Many of the challenges we face today aren't the result of a broken system. They're the result of a system designed for a different time. Healthcare was built for a different era.

The greatest mistake in healthcare leadership is believing today's challenges can be solved by optimizing systems designed for yesterday's realities.

Returning to an earlier version of healthcare will not solve today’s challenges. The system must be redesigned around the realities of how people now live, access information, and receive care.

To understand why, we have to understand the assumptions healthcare was built upon.

Those earlier assumptions still shape how healthcare is organized, financed, and delivered.

How We Got Here

Fifty years ago, the world operated on very different assumptions. Information moved slowly. Geography shaped access. Most services required physical presence. Consumers were expected to adapt to the systems around them.

Today, nearly every one of those assumptions has changed.

We communicate instantly across continents. Banking, shopping, travel, education, and entertainment can all be accessed from a device that fits in a pocket. People expect transparency, convenience, personalization, and immediate access to information.

Organizations that survived these shifts didn't simply improve old processes. They fundamentally redesigned themselves around new realities.

No one expects modern aviation to operate with paper reservations and radio dispatch systems from the 1970s. No one suggests that retail should return to mail-order catalogs. No one argues that banking should require every transaction to occur inside a branch.

We understand intuitively that when the world changes, systems must change with it.

So why would healthcare be any different?

The population is older. People live longer with chronic disease. Healthcare is no longer delivered within the four walls of a hospital. Patients move between physician offices, urgent care centers, hospitals, health plans, virtual visits, home monitoring devices, and digital health applications.

The ecosystem has changed.

The goal cannot be to return to where we were, but rather to build healthcare for the realities of today.

Designing Healthcare for Today’s Reality

We are still thinking about healthcare from yesterday’s perspective.

That shift begins by questioning assumptions that no longer reflect how people experience healthcare.

The longstanding assumption that healthcare professionals know best is giving way to a different reality: patients expect to participate meaningfully in decisions about their care.

Information that was once tightly controlled is now readily available, but most patients still lack the ability to judge the quality of information, creating confusion.

Patients are no longer willing to adapt to the healthcare system; systems must now adapt to the people it serves.

Patients see multiple providers, frequently on different health record platforms. Scheduling is its own complexity, especially as patients age and have multiple chronic conditions, requiring multiple visits at different locations each month.

A typical senior living with obesity, diabetes, COPD, atrial fibrillation, and hypertension may rely on a primary care physician, an endocrinologist, a pulmonologist, an electrophysiologist, and a general cardiologist. The system requires that patient to visit multiple offices, use multiple portals, interpret potentially conflicting instructions, and complete duplicative forms. A case manager assigned by the payer or clinically integrated network may also be involved but may not have access to the patient’s complete record.

Navigating benefits and understanding costs is a multi-layered problem with no clear solution. Explanations of benefits can be overly complex and difficult for most patients to understand.

And then there’s the uncomfortable truth.

Consumers fund healthcare through taxes, premiums, deductibles, co-insurance, and copays.

Yet despite being the primary source of funding, they have surprisingly little influence over how care is designed and delivered.

This reality should change how we think.

Instead of asking what works best for hospitals, physician practices, health plans, or regulators, we should begin by asking:

What does the person paying for and receiving care actually need?

That question sounds simple. In practice, it is transformative.

What patients need is not always the same as what they request clinically. Often, the deeper need is to feel heard and understood. Caregivers can acknowledge a patient’s concerns without affirming information that is inaccurate, creating the shared understanding needed for better decisions.

The difference between designing for the system and designing for the consumer becomes clear when we examine a common clinical pathway.

Clinical pathways are designed to reduce unnecessary variation and improve outcomes. That is important work.

Consider a patient who develops low back pain.

The evidence-based pathway may recommend screening for serious conditions, avoiding unnecessary imaging, initiating conservative treatment, and reassessing symptoms over time.

Clinically, this makes perfect sense.

Clinical variation increases costs when it leads to unnecessary care, and many of those costs are passed directly to patients. Unwarranted care can also expose patients to avoidable risks associated with tests, procedures, or facility visits that their condition does not require.

But the consumer is often asking a different question:

"Why does my back hurt, and how quickly can someone tell me what is wrong?"

If the pathway is clinically correct, how do we make the journey through it faster, simpler, and less frustrating?

The pathway is designed to reduce unnecessary variation and improve outcomes, but its success also depends on how the patient experiences each step.

The patient is seeking answers, reassurance, and relief.

Neither perspective is wrong.

Healthcare often measures what is important to the system. Consumers measure what is important to them.

The challenge is not choosing between clinical appropriateness and consumer expectations. The challenge is recognizing that both matter.

The best outcomes occur when patients feel heard and understood and can move seamlessly through reliable, high-quality care they can afford.

The future of healthcare is not simply better clinical pathways. It is better journeys through those pathways.

Imagine What Could Be

What if the real challenge isn't fixing healthcare?

What if the challenge is not fixing a system designed for another era, but finding the courage to imagine and build what healthcare should become?

Reimagining healthcare begins when leaders stop asking how to preserve the systems we inherited and start asking what people need now. The work is not to discard clinical rigor, operational discipline, or financial stewardship. It is to redesign how those strengths come together so that care is easier to navigate, more responsive to the people it serves, and capable of delivering better outcomes at a cost people can afford. Fixing what exists will not be enough. We have to build what comes next.

Helping People See What Is Possible.

Donna M. Bergman is an author, speaker, and healthcare leader exploring caregiving, leadership, resilience, and healthcare transformation.