In Atlanta, we often celebrate innovation — in business, technology and health care. Yet for many families across the metro area, the most basic part of health care remains the hardest: knowing whether they can afford the care they’re told to get.
As someone who grew up translating insurance letters for my immigrant parents, and who now trains in medicine in Atlanta, I’ve learned that the greatest barrier to care often isn’t access. It’s unpredictability.
A recent AP-NORC poll shows something rare: Americans across political identities agree that health care is becoming harder to afford. But affordability is not only about cost. It is about stability. And in a city defined by rapid growth and widening inequities, instability carries real consequences for families, employers, and health systems alike.
During training, I met a woman who began rationing her insulin after her insurer quietly shifted its formulary. Her copay doubled overnight. She was doing everything Atlanta’s health systems ask of patients — attending appointments, tracking her readings, following medical advice — and still felt punished. “I’m doing everything right,” she told me. “Why does it still feel like I’m losing?”
I’ve also met immigrant families who brought stacks of insurance letters to clinic visits. A service might be labeled “covered,” yet still come with an unexpected balance because of deductibles, cost-sharing, or billing codes no patient is trained to interpret. When families called for clarification, they were often sent back and forth between insurers and hospitals, each pointing to the other for answers.
This fragmented system places the burden of coordination on patients. Individuals are left to track down information, negotiate charges and reconcile conflicting explanations, often while managing illness, work and family responsibilities. What becomes a prolonged game of administrative “tag” costs people time, money, emotional energy and trust in the system.
In medicine, we refer to this breakdown as fragmentation of care. When responsibility shifts between institutions, specialists and insurers without seamless communication, patients are forced to repeat their stories, resubmit paperwork and navigate delays. The result is frustration, inefficiency, delayed payments for hospitals and added strain on already overworked clinicians and billing staff.
Across metro Atlanta, families describe the same patterns:
• Surprise billing for routine imaging
• Formularies shifting mid-year
• Difficulty obtaining prior authorization
• Deductibles reset before families are financially prepared
• Confusion caused by opaque and inconsistent billing
These are symptoms of systemic design.
At major institutions such as Grady Memorial Hospital, Emory-affiliated hospitals and community safety-net clinics, clinicians see the downstream effects every day: delayed care, overcrowded emergency rooms, preventable hospitalizations and mounting financial strain. When patients postpone treatment out of fear of cost, the burden ultimately shifts to hospitals, employers and taxpayers.
If Atlanta wants to lead in health care innovation, it must start with predictability.
That is why I believe in a framework I call Balanced Universalism, a practical approach that combines the strengths of public systems with private-sector innovation while protecting families from financial shock.
Balanced Universalism rests on four principles.
1. Universal Basic Coverage. Every resident receives a stable foundation of essential care: preventive visits, chronic disease medications, emergency services, maternity care and basic mental health support. This is not luxury insurance. It is stability.
2. Tiered Private Plans. Private insurers remain part of the system. Those who want expanded access can purchase supplemental plans. Choice remains. Vulnerability does not.
3. Fair Risk-Pooling Rules. Predictable caps on out-of-pocket costs, protections for pre-existing conditions, incentives for prevention and the ability to change insurers without penalty.
In a city where health inequities often mirror longstanding racial and economic divides, these protections matter.
4. Administrative Simplification. Transparent billing, standardized prior authorization and unified claims processes would reduce hospital overhead, relieve clinician burnout, prevent surprise billing and rebuild public trust.
Balanced Universalism reflects two consistent truths.
The emotional truth is that families become anxious when systems feel unpredictable.
The economic truth is that prevention is more cost-effective than crisis care.
Atlanta’s health care workforce is strained. Emergency departments are overcrowded. Safety-net hospitals operate under enormous pressure. Employers absorb productivity losses when workers delay care. Families who are insured still feel financially vulnerable.
For Atlanta to remain competitive, equitable and resilient, health care cannot remain a source of constant financial instability. When families delay care, costs ripple through the entire regional economy.
What families want is not perfection. They need predictability. Health care should not depend on luck, and in Atlanta, it should not depend on deciphering paperwork.
