Washington’s raging battles over health care finance reform are missing a fundamental point: the real problem with American health care is the fundamentally flawed business structure underlying its delivery. So far, no one is addressing it.

Most would agree that improving our nation’s health system is essential in order to preserve the protections of coverage and ensure that high quality affordable care will be there for our children and grandchildren.

As a pediatric anesthesiologist and citizen-legislator, I know first-hand the promise of modern medicine and the financial devastation that fulfilling that promise can hand a family. And as a former Democratic state Senator, I know how difficult it can be to find political common ground on contentious issues, especially those that inspire as much passion as health care reform.

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From an old-fashioned mom-and-pop shop where physicians hung out their shingles and made house calls to a massive and complex industry that accounts for over 17 percent of our nation’s GDP, American health care has rapidly progressed. But while the industry has advanced, today’s modern medicines, highly educated physicians and nurses, complex technologies and disparate hospital systems provide poorly coordinated, highly inefficient and expensive care.

The system is exceptionally good at caring for the very sick, injured and dying but poorly equipped to promote a healthy society and the healthy lifestyles that consume less care. It financially rewards hospitals, doctors, and pharmaceutical and technology companies for maximizing their sales volume, instead of rewarding the delivery of quality care that ensures value for the money spent and keeps people healthy.

ObamaCare was never meant to be the ultimate solution to these problems. It was intended as the first step in transforming a massive fragmented, immature industry into a highly consolidated and integrated business system, where intense market competition would improve operating efficiencies and eliminate redundancies while providing high quality care. But its promise has not been fulfilled.

Large industries typically pass through a series of changes as less efficient, less market-desirable entities that cannot effectively compete are merged into others or forced out of business. But the health care system has yet to undergo these fundamental changes. The answer to securing lower cost, high quality health care for all Americans is to fix that broken business structure and accelerate the health care industry’s passage through the normal business consolidation life cycle.

Only then, when the industry is highly consolidated and effectively integrated, will intense market competition deliver high quality, affordable care to all Americans.

With a new president in office — one who has pledged to repeal and replace ObamaCare — and a Republican-controlled Congress, modernizing and transforming America’s health care industry faces enormous challenges. In this hostile political environment, Congress must enact public policy that preserves and improves competition. Universal health coverage, originally proposed by the conservative Heritage Foundation, is a reliable mechanism to fund a competitive free-market health system. And since all Americans benefit from that system, it is only fair that all citizens help pay for it.

Next, in order to have healthy communities, health care should be tailored to the specific needs of each community and managed through national population health initiatives. Population health management works to improve the health of an entire population by acting on multiple factors that influence our health. Consolidated and integrated health systems are best equipped to manage population health because they can deploy their advanced flagship hospital talent and resources to rural and remote communities.

Finally, intense market competition in a highly consolidated industry will drive health systems to compete on price. By replacing the current expensive fee-for-service payment model with a value-based system, patients will receive higher quality, lower cost care with better health outcomes.

What is needed now in order to develop a consolidated and integrated health system is top-level political leadership. Leadership with the vision and business skills to guide the restructuring of a massive health care system and to raise awareness for Americans about the social and economic importance of a healthy society. That means people who recognizes our society’s moral obligation to achieve health equality. We can do this by constructing a system that enables all citizens to live a healthy life.

It is time for President Trump to be that leader, and to work with a bipartisan Congress and our nation to achieve consequential health system reform to secure high quality affordable care for every American.

Michael S. Katz, MD MBA, is a pediatric anesthesiologist, a former Delaware state Senator and Delegate to the American Medical Association.