American Health: Who Gets Paid

By: Robin Blackstone MD

Why does American health care cost so much and still fail to deliver health?

American Health—Who Gets Paid examines the pricing system that quietly governs US medicine—and explains why what gets paid for gets done. Rather than focusing on politics, personalities, or technology, the book looks at the underlying economics of medical work: how care is valued, who sets those values, and how payment rules shape clinical behavior, institutional priorities, and innovation.

The book explains how RVUs, billing codes, and closed-door valuation processes reward procedural intervention while systematically undervaluing prevention, judgment, continuity of care, and long-term accountability. It shows why innovation that improves outcomes often fails to scale—not because it doesn’t work, but because it threatens existing revenue streams. And it reframes physician burnout not as a personal resilience problem, but as a predictable consequence of being paid for volume while held responsible for outcomes.

As artificial intelligence and modern data systems make upstream care more effective and more visible, the book argues that the current payment model is becoming economically unsustainable. A system designed for episodic, acute care is now misaligned with a world dominated by chronic disease, long time horizons, and continuous risk management.

This book is written for clinicians, policymakers, employers, and anyone trying to understand why the US health system behaves the way it does. It does not offer partisan solutions or technical quick fixes. Instead, it provides a clear diagnosis of the economic architecture underneath American medicine—and explains why meaningful reform must begin with pricing, not politics.

American Health—Who Gets Paid is the first book in the American Health series, which moves from diagnosis to design in reimagining a modern US health system.

©2026 Robin Blackstone (P)2026 Blackstone Publishing