Health Care Is Too Complicated. It Doesn’t Need to Be.

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If you’ve ever tried to get mental health care and physical health care in California, you’ve probably noticed the two domains don’t talk to each other. If you’ve ever opened a medical bill and wondered what you’re actually paying for, you’re not alone. And if you’ve ever given up trying to get care because the system felt too confusing, you’re part of a growing majority.

California’s health care system is too complicated. It doesn’t need to be. We’ve built a system so tangled in rules, silos, and bureaucracy that it fails the very people it’s meant to serve. And it’s not just patients who suffer. Providers, health plans, employers, and even Medi-Cal administrators are caught in a web of complexity that makes care harder to deliver, harder to afford, and harder to trust.

Let’s break this down.

Patients Are Lost in the Maze

Survey after survey shows that patients are frustrated and overwhelmed by the complexity of our health care system, and that it is a major barrier to their health. They consistently say that they don’t know where to go when they need care, they avoid or delay care due to confusion about costs, they feel like their health care bills are too hard to understand, and they don’t understand how to navigate the claims and appeals processes. And that’s without acknowledging that families who need behavioral health care often have to deal with a completely different system. Care for serious mental illness and substance use treatment are carved out of most health care plans, forcing people to bounce between networks, eligibility rules, and referral pathways. It’s confusing, inefficient, and often leads to delayed or forgone care. We’ve built a system where patients need a map, a translator, and a lawyer just to get care.

Providers Are Drowning in Red Tape

Doctors and nurses are overwhelmed by endless metrics, multiple contracts with different plans, and administrative burdens that take time away from patients. A single provider might belong to several medical groups, each tied to different independent practice associations and health plans, each with its own rules, forms, and reporting requirements. Physicians spend about 15-20 hours per week on paperwork alone. Burnout is rising. Good clinicians are leaving the field — not because they don’t care, but because the system doesn’t care about making their jobs doable. More than 40% of doctors report burnout symptoms, leading to a projected shortage of 124,000 physicians by 2034. We’ve created a system where doctors spend more time navigating paperwork than treating patients.

Systems Built to Manage Complexity — Not Solve It

Health plans have built massive bureaucracies just to manage fragmentation. Medi-Cal — our safety net — is tangled in multiplying federal funding streams, forcing states to pit beneficiary groups against each other instead of designing rational, equitable programs. Administrative costs in U.S. health care eat up 25%-31% of total spending, compared to 5%-10% in more streamlined systems abroad. And employers are depressing wages to cover these inflated health care costs. We’ve created a system that rewards complexity instead of care.

Four Things That Give Me Hope

Even while our systems are getting ever more complex, there are bright spots and opportunities that suggest this might be a moment for change.

• CalAIM represents a once-in-a-generation opportunity to break down silos. After years of pilots and planning, California is transforming Medi-Cal from a patchwork of disconnected programs into a more integrated system. CalAIM is working to connect physical health, behavioral health, and social services — bringing together care that has been artificially separated for decades. While implementation challenges remain, this reform demonstrates that even our most complex systems can be redesigned with people at the center.
• AI and emerging technology could be a powerful tool for relieving administrative burden. Early applications of AI in health care are showing promise in reducing paperwork, streamlining prior authorizations, and helping patients navigate their options. California’s Health Data Exchange Framework is laying the groundwork for better information sharing across providers and systems — a critical foundation for technology solutions that could cut through red tape. While we need to be thoughtful about implementation and equity, technology offers real potential to reduce administrative burden for patients, providers, and plans alike.
• The affordability crisis could create strong incentives for more efficient systems. When health care costs squeeze family budgets and state resources, stakeholders across the system have stronger motivation to eliminate waste. Recent federal policy changes may accelerate this pressure, creating an environment where simplification becomes not just desirable but necessary.
• In California, purchasers and plans are increasingly aligned on common metrics. We’re seeing growing commitment from major health care purchasers and Medi-Cal managed care plans to use consistent quality measures and reporting standards. This alignment, while still emerging, suggests that stakeholders recognize the value of reducing fragmentation.

And while I don’t profess to have all the answers, I’m hoping to start a conversation about what we could achieve if together we really leaned into reducing complexity.

We Could Simplify

We need bold simplification. This is a moment where we could take transformative steps to leverage technology, incentives, and coordination to cut waste and improve outcomes.

Some might say it’s impossible to simplify something as massive as health care. And others might say that we need a full system overhaul or single-payer health care to deliver it. But history proves otherwise. Look at how countries and large international industries have tackled big complexities within their existing systems in different domains — and won. These aren’t prescriptions for health care; they’re proof that big systems can be streamlined for the better:

• The move to chip card payments was an industry-led effort to standardize and secure transactions. Spearheaded by Europay, Mastercard, and Visa in the 1990s, the U.S. migration accelerated in 2015. The change introduced chip cards that perform cryptographically, which slashed counterfeit card fraud and standardized the ways terminals authenticate payments. For the public, this meant that using a credit or debit card has become a more secure and reliable experience, leading to dramatically reduced counterfeit fraud and a more consistent checkout process across different merchants.
• The global shipping industry’s adoption of standardized shipping containers was a private-sector revolution that transformed world trade. Led by a trucking entrepreneur in the 1950s and developed through the International Organization for Standardization in 1968, the industry voluntarily shifted from break-bulk cargo handling to the 20-foot and 40-foot containers that now dominate maritime transport. Shipping lines, port operators, and trucking companies coordinated investments in compatible equipment — container ships, cranes, and chassis. All this happened through voluntary industry coordination rather than government mandates, though government customers — particularly the U.S. military — played a significant role in early adoption and proving the concept at scale. The result was dramatic: loading times dropped from weeks to hours, theft and damage plummeted, and shipping costs fell sharply. For consumers, this invisible change enabled the global economy we know today, making international trade economically viable for countless products and fundamentally reshaping supply chains worldwide.
• The global airline industry’s shift from paper to electronic tickets was a massive, coordinated effort led by the International Air Transport Association through its “Simplifying the Business” program. IATA set a 2008 deadline for achieving 100% e-ticketing, while standardizing formats and aligning incentives for airlines, travel agents, and global distribution systems. Passengers saw the emergence of a simpler travel experience, while airlines achieved multibillion-dollar cost savings and successful industry-wide modernization.

If credit card companies, the shipping industry, and airlines around the world could align to deliver more seamless approaches for consumers and corporations, why can’t California streamline health care?

We’ve done big things before. It’s time to simplify for the sake of patients, providers, and our future.

Let’s simplify everything.