Health Affairs writer John O’Shea explains the conflicting signals being sent by the current administration regarding payment reform in Medicare and the attempted move away from fee-for-service and toward patient-centered care and value-based care. He correctly notes the how excessive regulatory burdens stifle innovation and creativity. However, his review of the government-led alternative payment projects unintentionally reveals the complete insanity of the system. He discusses and compares and critiques programs MIPS, QPP, and APMs ! No one can seriously believe that meaningful solutions will from the likes of MedPAC, MACRA, PTCA ! The entire article is about how physicians will get paid. Amazingly, barely mentioned at all as a part of the solution are the customers, i.e., the patients. This is not how Amazon or Google or Apple would go about solving the healthcare system. What doctors and healthcare policy wonks fail to realize is that the public, employers and even legislators have had it with the healthcare establishment and don’t take their input seriously anymore. That is why Amazon, Berkshire Hathaway and JPMorgan have decided to go at it and fix it themselves. They don’t want to be doing this. But they have no choice. The good news is: the problem it is solvable. The right company will focus first on the customer. And we have no doubt that there will emerge a company that creates a system to for millions and millions of customers by delivering a great experience at an affordable price. It may have to take place outside of the traditional insurance and legacy medical ecosystem. But that company is waiting to break loose today.