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.