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Over the 40 years prior to my retirement in 2014, I worked to promote access to high quality healthcare at an affordable cost. Based on abject failure in accomplishing those goals, to wit, today’s health care affordability crisis, I’ve been reflecting on where we went wrong, e.g., managed care, “competition,” and some regulations; and where we should go now: standardizing medical necessity determination, simplifying and limiting the number of health care plan designs and expanding Medicare to those aged 55-64.