By Chad Savage, M.D.
With the reelection of Donald Trump and the potential involvement of transformative figures like Elon Musk and Robert Kennedy Jr., the United States may have a unique opportunity to reform health care in ways not seen in generations.
It’s widely recognized that our current healthcare system is severely flawed. Health care comprises nearly one-fifth of the U.S. economy and is bogged down by layers of administrative and bureaucratic inefficiencies that inflate costs, distort incentives, and hinder both quality and accessibility of care.
The bloat is substantial: nearly half of health care jobs are non-clinical, meaning they are held by people who do not meaningfully interact with patients—positions like billers, coders, administrators, and bureaucrats. These jobs often add little to no value but instead, bureaucratize care at a massive financial and health cost.
Many of today’s health care problems can be traced back to the fact that control has been relinquished to governmental and insurance third parties that relegate the patient to a secondary role, where financial transactions occur between providers and third parties rather than directly involving patients.
Opposing true reform are powerful but parasitic entities that have enriched themselves at the expense of patients, their health, and society. Effective change will not come from top-down tweaks that merely paint over the cracks in the current broken system; rather, it will require transformative incentives that cause the system to reform itself.
The Power of Self-Pay
The foundation of this change is to restore the patient as the primary payer in healthcare, and thus the center of the system’s focus. Doing so would eliminate waste, price distortions, and the inherent conflicts of interest in the current system.
A simple shift away from third-party control to patient control would trigger a domino effect of meaningful change, introducing incentives for providers to either reform or go out of business. Health care entities, now beholden to patients instead of third parties, would compete to provide the highest quality, cost-effective care, as judged by the end consumer: the patient.
Central to this approach is the understanding that patients already pay for their care at inflated rates. However, the full extent of this expense is hidden under layers of taxes, premiums, wage deferrals, copayments, and other charges.
Mechanisms already exist that, with minor modifications, could prevent this diversion to third parties and instead allow investment in patient-controlled Health Savings Accounts (HSAs) for younger patients and Medical Savings Accounts (MSAs) for Medicare recipients. These accounts should be separated from traditional insurance and usable for paying premiums for insurance, health-sharing plans, short-term policies, or other options deemed best by the patient to meet individual needs.
By controlling these tax-preferred accounts, patients would access the care they want—not just what a third party allows. Restrictive networks, obstructive authorizations, or referrals would no longer stand between patients and their care. With the guidance of a trusted physician, the only authorization a patient would need is their own. As consumers, patients would demand high-quality, cost-effective, accessible care from their providers—and if unsatisfied, they could take their dollars elsewhere.
The Domino Effect
This patient-centered payment method would be flexible enough to allow for rapid innovation, no longer restricted by the archaic third-party payment system that only recently recognized, under pandemic pressure, the utility of telehealth.
Legacy healthcare establishments would be placed under positive stress to provide value, or risk being outcompeted by providers better meeting patient demands. Insurance, while still necessary, would return to its intended role as a financial tool to prevent catastrophic financial loss, rather than the overriding manager of all medical care.
For those truly unable to afford even this more affordable model, a means-tested approach could support their accounts, with contributions from family, friends, charities, or the government. These patients would still control their funds and engage in free-market incentives to help rein in excesses in the healthcare system.
Though simple, this approach could transform our health care system, potentially halving our $4.8 trillion price tag. Such savings—on par with the GDP of entire nations—could reduce the national deficit, alleviate the leading cause of bankruptcies, and lower employment costs, thereby enhancing the competitiveness of American companies in the global market.
With Trump’s solid victory, with his party behind him in the U.S. Senate and likely the U.S. House, we are at an unprecedented crossroads. The question remains: will we seize this opportunity?
Chad Savage, M.D.
(chad.savage@yourchoicedirectcare.com) is a Heartland Institute Policy Adviser. Docs 4 Patient Care Foundation policy fellow and the President of DPC Action. A version of this article was published on November 13, 2024 by Red State. Reprinted with permission.