Four days a week, I take calls for a Maine-based healthcare provider. The calls run the gamut: people are sick, they want to fill their prescriptions (and there are lots of pills being pushed), or they make some variation on a common theme—demanding some kind of service (often that day), demonstrating how little they know about how broken our healthcare system really is.

Back in the late 1990s, I worked for another healthcare provider. We were an HMO, back when HMOs were supposed to save the day and reinvent medicine in America. More important in this discussion was that HMOs were expected to be the cost-containment deemed necessary at that juncture. HMOs did not save healthcare.

I really liked my gig back then. The organization was locally-managed and really had a humane, quality-focused approach to healthcare. Where I’m at now often reminds me of that time 20 years ago. However, the organization with skilled local management got swallowed like Jonah getting inhaled by the whale. A corporate giant vacuumed up the business based in Freeport and almost overnight, everything went downhill.  Profit became the primary motif and most of our group who were hired together to service a block of Midwestern business, scattered to the four corners of the work world. Some of us ended up at a disability insurer I’ve often referred to as Moscow Mutual. That’s another story I’ve written about, including in a book of essays that mainly ended up being relegated to the publishing dustbin.

Elizabeth Warren, one of the bloated field of Democrats, released details recently about her Medicare for All plan, her solution for overhauling American healthcare. As soon as Warren dotted the I’s and crossed the T’s of her plan, the critics crawled out from their corners, detailing why moving from a broken system to one covering everyone, lowering costs, and improving care outcomes won’t work.

Others are talking about how we can reform an unsustainable model.

Marty Makary is a surgeon. He has a new book, The Price We Pay: What Broke American Healthcare and How To Fix It. At least he get the brokenness of the system right. But so do most politicians. It’s just that they don’t seem to know how to fix it.

Unnecessary procedures keep pushing up the cost of U.S. healthcare.

Makary makes a number of prescriptions for fixing healthcare. One of the more interesting ones is the unnecessary elements of healthcare. These are the procedures: tests, surgeries, prescriptions that have bloated healthcare’s costs, pushing it north of the $3 trillion dollar mark.

Makary makes note of the Johns Hopkins survey of medical providers in the book that indicates that 21 percent of procedures performed were unnecessary. That’s one-in-five medical procedures.

Older Americans are often the worst offenders. Unlike the generation going out into the world who are under-insured, many of them have had health coverage across their work lives. Some of them have had the entire cost of their coverage picked up by employers, too. And they are the most entitled.

I sold Medicare advantage plans for two years. These Medicare enhancement plans push annual wellness visits. There are a host of other care options that promote the use of healthcare. And in using healthcare, waste is regularly built into that usage. Makary illustrates this when he highlights how he visited a church health fair. He was tipped-off about this from a cardiologist who told Makary that doctors recruited patients at these fairs.

According to Makary, these were in all-black areas and doctors would check seniors’ circulation for free. As Makary noted, this inevitably led to scheduled appointments and eventually, lead to unnecessary procedures.

Makary’s book is worth reading. I agree with him on a number of points. However, like so many other failed proposals to “fix” healthcare, Makary ultimately believes that the market is the solution. He’s opposed to solutions like Medicare for All. For Makary, it’s all about creating “healthy markets” that “eliminate the middleman.” Yeah, right. That hasn’t happened over the past 25 years. Only a slavish devotion to a belief in capitalism would elicit that kind of response to the crisis. But that’s what is offered by someone from the inside.

I’ve always liked Elizabeth Warren’s advocacy for the lower and middle classes. I knew about her work long before she contemplated running for president. I think she’s bringing forth important solutions. She also finds a way to move beyond relying on “the market” to fix what it’s never had any intention of fixing.