Dr. John Kitzhaber spends a lot of time talking about health care: He was an emergency room physician, and a two-term governor of Oregon. He's seen it all from both sides and says America's healthcare system is just plain broken.
"It's a system that sort of lies in the weeds until people are very, very sick," he said, "and then rushes in with extraordinarily marvelous and expensive high technology to help you recover on the back end."
It's about a series choices -- and Kitzhaber thinks we're making the wrong ones.
"Should 95-year-old grandpa's quadruple bypass surgery be paid at the expense of his six-year-old granddaughter getting immunizations and a routine checkup at her pediatrician?" he asks. "That's the larger question."
Doctors, patients and policy-makers all have ideas about why the health care system is in critical condition. That's partly why ABC News will be taking a week-long, comprehensive look at the problems and the possible solutions for a system that has left millions of people uninsured, unhappy and unhealthy.
As part of the series, ABC News, the Kaiser Family Foundation and USA Today polled people across the country. Just 44 percent said they are satisfied with the overall quality of health care, and only 18 percent were satisfied with the cost.
That cost impacts everyone. Last year alone, federal spending for health care totaled more than $600 billion, about a quarter of the entire federal budget.
Some of the biggest questions critics raise about America's healthcare system have to do with insurance, which 46.6 million Americans -- or 15.9 percent -- do not have, according to U.S. census figures. While most Americans say they are satisfied with the care they get, the United States is the only industrialized country that does not guarantee health coverage for everyone.
"We do have a de facto policy of universal access: It's called the emergency room," Kitzhaber said. "Then those uncompensated costs are shifted back to people who have insurance coverage by increasing their bills or increasing their insurance premiums.
"If we were able to capture in a legislative concept the system we have now, it would not even get a committee hearing," he added. "I don't believe it would reach the floor of the Congress [because] no one would vote for it, no one could defend it. No one could defend a system that essentially puts U.S. employers at a competitive disadvantage -- or [defend having] the enormous inequities in terms of who gets the benefits of the public subsidy and who pays them. No one would do that."
Sick people not sufficiently covered by private insurance plans often have the cost of their care picked up by the government via Medicare or Medicaid.
Mamie Jackson has had trouble with her kidneys most of her life, and they finally failed 10 years ago.
"If I wake up … and nothing is hurting and I'm not nauseating and throwing up, I'm having a good day," she said.
The state college professor in Los Angeles had grown up dirt poor in the South and had finally made it -- so for her, the doctor's words about her illness were devastating.
"I kind of went into shock and went numb, because I was in my early thirties," Jackson said. "And he's telling me … you're not going to be able to work anymore to take care of yourself."
No job meant no insurance. No insurance meant no operation. To qualify for public assistance, she actually had to become poor again.
"I had to spend all my money in order to be able to get that help from the county," she said.
Eventually, she qualified for Medicare and got a kidney transplant.
Another problem is that not everybody with a job has insurance. According to the Kaiser Family Foundation, more than two-thirds of the uninsured actually work. For those who can't afford insurance, but earn too much for public assistance, the consequences can be severe.
"These people … delay seeking treatment for minor problems until they become major problems," Kitzhaber said. "And so it's a significant contributor both to the cost of the system and to the troubling health statistics of our population."
But even those who can pay face risks, like medical mistakes. An estimated 100,000 Americans die annually from medical errors -- twice as many as in car crashes, according to the Institute of Medicine.
In Indianapolis last month, tiny Thursday Dawn Jeffries and two other premature babies died after accidentally being given 1,000 times the prescribed dosage of a blood thinner.
"I think it was wrong," said her mother, Heather Jeffries. "My baby was fine before they gave her the Heparin."
It is not just patients. Doctors also say the system is broken. In some parts of the country, it's hard to even find someone to deliver a baby because it's considered a high risk specialty. According to the American College of Obstetricians and Gynecologists, one in seven ob-gyn's in the United States has stopped delivering babies because of the cost of malpractice insurance.
In northern New Jersey, Dr. Ruth Schulze has delivered close to 3,000 babies. Last year, she stopped because the cost of malpractice insurance was so high and the money insurance companies paid for each delivery was so low.
"It became a harsh reality of economics," she said. "In private practice medicine, you still need to run a small business. And unfortunately, the price of business was going up and the reimbursement level was going down. … And the penalties associated with practicing got to be great enough that as much as we love it, it was a very logical but painful decision to stop."
But it hasn't been easy to make the adjustment.
"There's a lot of sadness in the fact that we're giving up something that we truly love doing, that we feel we actually deliver in a quality fashion," she said. "There is nothing in the world like delivering a baby."
In the end, all the expense and all the cracks in the system may take their toll, some say.
"If spending money on healthcare made people healthy, we'd be the healthiest nation in the world," Kitzhaber said. "And the fact is that our health statistics are abysmal compared to some of the other countries that we compete with."
ABC News' Lenny Bourin and Dan Harris contributed to this report.