American healthcare consumes nearly twice what other developed nations spend while delivering worse outcomes-wasting more annually than the entire Russian economy. Communities across America have solved this crisis, and this book shows exactly how they did it.
Dave Chase identifies two structural flaws at the heart of U.S. healthcare dysfunction: the rigid separation of healthcare and social care funding, and governance stuck at the wrong scale. These flaws interlock, ensuring reform efforts consistently fail regardless of ideology. Community-Owned Health Plans address both flaws simultaneously, drawing on the cooperative principles that transformed rural electrification a century ago.
The evidence spans decades. Rosen Hotels in Florida saved $570 million over 30-plus years while managing a workforce where 65% of pregnancies are high-risk. Alaska's Nuka System cut emergency visits by 50% and hospital admissions by 53%, sustaining 97% customer satisfaction for over a decade. Ashtabula, Ohio's small school district saved $2.4 million in year one while eliminating deductibles and preventing teacher layoffs. More than 10,000 employers covering over five million Americans have adopted these approaches, with track records spanning 5 to 30-plus years and cost reductions of 20% to 50%.
Guided by Father José María Arizmendiarrieta's cooperative wisdom, Chase maps a practical path from broken system to community ownership. The Basque priest built the Mondragon cooperative network of 100-plus worker-owned enterprises. If cooperatives transformed a war-scarred town under fascism into a thriving democratic economy, American communities can reclaim their rivers of healthcare dollars.
As AI displaces millions of jobs, this book reveals how communities can capture the "AI Catalyst" by redirecting healthcare waste into workforce development and social investment rather than paying an "AI Tax" of unemployment and decline.
The blueprint exists. Nautilus Health Institute democratizes the tools. Success stories multiply. What communities need now is the courage to act, community by community, until the transformation becomes unstoppable.
Dave Chase has reached millions of Americans through his books, speaking, media appearances, and TEDx talk "Healthcare Stole the American Dream - Here's How We Take it Back."As co-founder of Health Rosetta, Chase has guided thousands of employers covering over five million Americans to achieve world-class healthcare at 20-50% lower costs. These audited results come from organizations ranging from 50-person manufacturers to 200,000-member unions, sustained over 5 to 30+ years.In 2024, Chase launched Nautilus Health Institute as an independent nonprofit to democratize these proven solutions. Through open-source tools, model contracts, and data infrastructure, Nautilus makes sophisticated healthcare transformation accessible to any organization, eliminating the need to reinvent approaches that already work in hundreds of communities nationwide.Chase co-created RosettaFest, the annual conference where thousands of benefits advisors, physicians, employers, union leaders, and cooperative leaders gather to replicate healthcare fixes that deliver measurable results. The conference features the Rosie Awards, recognizing America's highest-performing health plans.His previous books include the bestselling CEO's Guide to Restoring the American Dream, The Opioid Crisis Wake-Up Call, and the HIMSS Book of the Year Engage! Transforming Healthcare Through Digital Patient Engagement. His work has appeared in The New York Times, Wall Street Journal, and Forbes.Chase previously founded Microsoft's healthcare business and co-founded Avado (acquired by WebMD/Medscape). He received the World Health Care Congress' Lifetime Achievement Award for Health Benefits Innovation.
