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Medical Case Presentation: The US Healthcare System


The James Madison Project utilizes the medical case presentation to address the many challenges facing our healthcare system, focusing particularly on practical solutions to the escalating unsustainable costs in the system and the increasing lack of access to quality care for more and more Americans.


The treatment plan of the Medical Case Presentation offers a multistage action plan divided into immediate, short and long term actions for addressing the challenges of the US healthcare system. The treatment plan format allows us to engage in a healthy deliberative political process toward our vision:


A sustainable system that provides access to quality, affordable healthcare for all Americans.


It offers a much needed change to the current political dialogue and reframes the challenges we face by asking the question:


How can we all, including the private sector, non profits, government and citizens, best achieves effective solutions to our problems, solutions that will work in a complex world of escalating need and diminishing resources?


We believe that together, following a treatment plan, we can solve the healthcare problems and build a system that is uniquely American and that we can be proud of, and change the political culture that has been so destructive.


Identifying Information

This section provides identifying information on the person or system that is the subject of the case presentation, in this case, the U.S. healthcare system as a whole.


The United States’ healthcare system provides healthcare services to the nation’s population and includes provider services, support services, research, and education. Healthcare services are provided through multiple venues. The cost of healthcare services is estimated to be $2.7 trillion a year, or $7,029 per person living in the U.S. The system is financed through a patchwork of payers, including government-provided (Veterans Affairs, prison, Military), government-financed (Federal Employees Health Benefits, Medicare, Medicaid), employer-provided systems, as well as coverage purchased from private insurance companies and safety net programs.


Chief Complaint (The Challenge)

This section describes the problem to be addressed in a brief concise manner. Usually it reflects the problem in the patient’s words.


Our society has failed to develop a sustainable system that provides access to quality, affordable healthcare for all Americans. Medical care techniques continue to improve and are growing more sophisticated every day. But the costs are not sustainable, and the system fails to meet the basic needs of more and more Americans.

The challenges are significant – more than 300 million people require healthcare services that address the 10,000 unique ways the body can fail. Execution of this care must work within a system that includes thousands of delivery systems and millions of providers with countless financial arrangements to compensate stakeholders.


More specifically:

  • The cost of health care is too high at every level – for individuals, communities, local organizations and corporations. These rising costs impact other public goods and spending.

  • Too many Americans lack access to health care through an increasing number of uninsured and underinsured individuals and families.

  • The current level of unsafe and suboptimal care is unacceptable. People deserve access to quality safe affordable healthcare.



Symptoms of US Healthcare System


Healthcare Costs

No matter how you look at it, healthcare costs are far higher in the United States than in any other advanced nation. Whether the costs are measured in total dollars spent, as a percentage of the economy, or on a per-capita basis, healthcare costs are out of control. 


Insurance Coverage for Healthcare Services

It is estimated that 30 million Americans are uninsured or underinsured. That lack of coverage directly contributes to numerous deaths a year. Because most people receive their health insurance through their employers, workers feel obligated to stay at a job for continued coverage. 


Access to Healthcare Services

America’s healthcare delivery system is patchy and fragmented, limiting needed services and the effectiveness of care based on location, economic status and age. For some, access and choice is severely limited – often by insurance providers. 


Quality Care

The current system provides very sophisticated care to those who can afford it. But that’s of little comfort to the many who suffer from incorrect diagnoses and treatment, including fatal medical errors, which are responsible for tens of thousands of deaths every year. 



Innovation in the current system faces the same challenge again and again – new treatments and diagnostic tests are developed based on economic potential rather than the need for improved health outcomes. Regulatory, legal and economic forces often stifle innovation by adding to the costs of new devices and products. 


Coordinated Care

The fragmented condition of our healthcare delivery system often causes not only expensive redundancies, but also dangerous treatment conditions. The lack of communication between providers and stakeholders often results in missing or conflicting diagnoses, medical errors, repeating treatment and a loss of important data. 

Sections of the Medical Case Presentation 


Define the Problem:

  • Identifying Information

  • Chief Complaint (Problem)

  • History of Present Condition


Current Treatment:


Past Treatment: 


Social History:


Family History: 


Data and Facts: 

  • Review of Systems

  • Examination

  • Data


Diagnosis of the Problems/Challenges:

  • Discussion

  • Problem List


Treatment Plan:


Progress Reports:

The Healthcare Ecosystem

Shrink the Government 

Diagnosis of the Problems/Challenges

Join the conversation to address the challenge of healthcare. 

Progress Reports 

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