Why Healthcare Keeps Getting Pricier - and Three Reforms That Could Move the Needle

Americans spend $4.3 trillion annually on healthcare - about $13,000 per person. That's roughly double what people in other developed countries pay, yet we have worse health outcomes and leave 28 million people uninsured. The system isn't just expensive; it's economically destructive.

The Price Opacity Problem

Try to find the price of a medical procedure before you get it. You can't. Hospitals charge different patients wildly different amounts for identical services. An MRI might cost $400 at one facility and $3,000 at another, five miles away.

This isn't a market - it's a pricing free-for-all where consumers can't shop around and providers can charge whatever they want. Insurance "negotiated rates" often bear no relationship to actual costs.

The Insurance Shell Game

Health insurance doesn't work like car insurance. You don't buy it to protect against rare, catastrophic events - you need it for routine care because everything is overpriced. A basic doctor visit costs $200-400 without insurance, not because it's expensive to provide, but because the system is designed around insurance payments.

Meanwhile, insurance companies make money by denying claims and limiting access to care. They're not trying to make healthcare affordable - they're trying to collect premiums while paying out as little as possible.

The Employment Trap

Employer-provided insurance sounds nice until you realize it traps workers in jobs they might otherwise leave. "Job lock" prevents entrepreneurship, career changes, and labor mobility. It also gives employers enormous power over workers' basic healthcare access.

The tax code subsidizes employer insurance while penalizing individual coverage, creating a system where losing your job often means losing healthcare exactly when you can least afford it.

Reform 1: Real Price Transparency

Require all medical providers to publish real, enforceable prices for common procedures. Not "estimated ranges" or "depends on your insurance" - actual prices you can count on. When patients can shop around, prices fall dramatically.

Oklahoma City's Surgery Center of Oklahoma posts prices online and charges cash patients 60-80% less than nearby hospitals for identical procedures. Price transparency works when providers actually have to compete.

Reform 2: Decouple Insurance from Employment

End the tax preference for employer-provided insurance and give everyone the same tax break for health coverage, whether through an employer or individual purchase. This would create actual insurance markets where people choose plans based on value, not just what their employer offers.

Allow insurance to be sold across state lines and let people keep their coverage when changing jobs. Make insurance actually portable and personal.

Reform 3: Direct Primary Care Expansion

Direct primary care eliminates insurance companies for routine care. Patients pay doctors directly - typically $50-100/month for unlimited visits, basic procedures, and direct communication. For predictable, routine care, this model costs about 80% less than traditional insurance-based care.

Combine direct primary care for routine needs with catastrophic insurance for major medical events. This approach covers both everyday care and financial protection while eliminating much of the bureaucratic overhead that drives up costs.

Why Change Is Hard

The current system creates enormous profits for insurance companies, pharmaceutical companies, and hospital systems. They have powerful lobbying operations and deep pockets to fight changes that would reduce their revenues.

Meanwhile, most people only experience the healthcare system when they're sick and vulnerable - not the best time to comparison shop or advocate for systemic change.

But the status quo is unsustainable. Healthcare costs are rising faster than wages, and medical bankruptcies affect 530,000 families annually. The system that's supposed to heal people is financially destroying them instead.