About the Foundation

Mission

The Imperative Foundation was formed to accomplish what Congress cannot and will not do: reform U.S. health care and transition the nation to universal health care. For decades, the U.S. has overpaid by more than twice the amount paid by peer nations on a per-person basis. In twenty-five years alone, from 1999 to 2024, the U.S. overpaid by more than $40 trillion as compared to the average of our peer nations.

There are two fundamental problems that have prevented reform of U.S. health care:

  • Congress's alignment to the health care industry rather than to the needs of its people and the nation.
  • Our for-profit health care system is structured and incentivized to generate revenues and profits for the health care industry, which severely compromises Americans' access to and the delivery of quality health care.

Why Now

  • Health care has become unaffordable for citizens, employers, and the federal government.
  • In a 2021 survey of large employers, 87 percent said providing health benefits at current cost growth would be unsustainable.
  • Medicare and Social Security are both projected to be underfunded in 2033, with Medicare paying only 89 percent of promised benefits to a projected 78 million beneficiaries.
  • Generations X, Y, Z, and Alpha are paying for Medicare and Social Security benefits they will not receive, and inheriting roughly $175 trillion in unfunded Medicare and Social Security obligations.
  • Annual federal deficits of $1.5 trillion since 2015 and a national debt projected to exceed $40 trillion in 2026, have made it improbable to impossible for the federal government to provide the needed capital presently or by 2033 to prevent an insurmountable health care financial and social crisis.
  • Only deep reform of U.S. health care can reverse these trends.

These current and impending crises are not separate financial or social problems. They are one problem with multiple compounding faces. The congressional strategy to push hard choices onto future generations has reached its limit. We now face an insurmountable crisis unless we reform health care now.

History

The case for reforming U.S. health care — and the framework for how to achieve it — was developed over four decades by the Foundation's founder. What was once a long-term argument has become an immediate crisis. The financial pressures on citizens, employers, Medicare, and Social Security have converged in ways that make the need for reform both undeniable and urgent. The window to act before these crises become irreversible is closing.

The Foundation was granted 501(c)(3) status in 2025.