Everyone agrees the healthcare system needs to change. But almost no one agrees on how to change it. And even when they do? It takes forever.

For decades, we’ve known Medicare’s financial challenges were coming. The math hasn’t changed. The program continues to spend more than it brings in, and the demographic reality is unavoidable: more retirees, fewer workers, and escalating healthcare costs.

Across the country, the cost of living looks very different. What it takes to live in New York City isn’t the same as what it takes to live in Charlotte. But when it comes to federal tax deductions, Medicare policy, and national funding structures, we often treat every place and every taxpayer as if they’re operating in the same economy...

We don’t like to think in limits. But whether it’s your personal budget, your long-term goals, or a global energy transition, finiteness controls everything. It’s the reality we don’t want to face: our resources, time, and attention are all finite. And when we forget that, we make poor decisions, both individually and collectively...