The Simple Fix to America’s Healthcare Affordability Crisis
We’ve overcomplicated healthcare in America. What started as a system meant to protect people from catastrophic costs has morphed into a byzantine maze where nobody knows what anything actually costs until the bill arrives. But there’s a straightforward solution staring us in the face—one that requires no new bureaucracy, no government takeover, and no reinvention of the wheel.
The answer? Transparency, individual control, and getting back to basics.
The Pricing Shell Game Needs to End
Here’s something most Americans don’t know: when you walk into a hospital without insurance, you’re often quoted prices that are two, three, or even ten times higher than what insurance companies actually pay for the exact same service. It’s called “usual and customary” pricing, and it’s one of the most egregious scams in modern commerce.
An MRI might be billed at $3,000 to an uninsured patient, while the insurance company’s negotiated rate for that same MRI is $400. Same machine. Same technician. Same 20-minute procedure. The only difference? One patient has leverage through an insurance company, and the other doesn’t.
This needs to stop. Tomorrow.
Every hospital, every clinic, every healthcare provider should be required to offer their negotiated insurance rates to every patient, regardless of insurance status. If Blue Cross pays $400 for an MRI, that’s what everyone should pay. Period.
The Domino Effect of Real Pricing
Once we eliminate the pricing shell game, something remarkable happens: healthcare becomes actually affordable for regular services. A basic doctor’s visit runs $80-120 at negotiated rates. Blood work? Maybe $30-50. Even that MRI we talked about is suddenly manageable at $400 instead of $3,000.
When services cost what they actually cost, we can finally move away from the prepaid medical services model we’ve been calling “insurance.” Real insurance is supposed to protect you from catastrophic events you can’t predict or afford—house fires, major accidents, serious illnesses requiring hospitalization. It’s not supposed to be a payment plan for routine, predictable expenses.
Enter the HSA-First Model
With transparent, negotiated pricing across the board, we can shift to a system built around mandatory Health Savings Accounts backed by catastrophic coverage. Think of it as the healthcare equivalent of having comprehensive auto insurance with a reasonable deductible—you pay for oil changes and new tires yourself, but if you total your car, you’re covered.
Here’s how it works: Every working American contributes to their HSA—pre-tax dollars that roll over year after year. These funds cover routine care, preventive services, prescriptions, and minor procedures. Behind that sits a catastrophic insurance policy that kicks in when costs exceed a reasonable threshold, protecting families from financial ruin due to serious illness or injury.
The beauty of this model is that it puts patients back in the driver’s seat. You decide whether you really need that specialist visit or if your symptoms might resolve on their own. You weigh whether the name-brand drug is worth the extra $50 over the generic. You ask about costs upfront because it’s your money on the line.
Cutting Out the Middleman Inefficiency
Our current system is drowning in administrative waste. Entire departments exist solely to fight with insurance companies over pre-authorizations, billing codes, and coverage determinations. Doctors spend more time on paperwork than patient care. The average hospital employs more billing specialists than nurses.
An HSA-and-catastrophic model slashes this overhead dramatically. Most transactions become simple: patient pays provider directly from their HSA. No claims processing for routine care. No fighting over whether that physical therapy was “medically necessary.” No three-month delays waiting to find out what you owe.
The only time traditional insurance administration kicks in is for major medical events—which is exactly when you actually need expert help navigating complex treatments and hospital systems.
Personal Responsibility Drives Better Outcomes
There’s an uncomfortable truth we don’t talk about enough: when people have no financial skin in the game, they make different choices. Not always worse choices, but different ones.
When healthcare feels “free” because you’ve already paid your premiums, there’s less incentive to shop around, question whether a test is really necessary, or take preventive steps to avoid needing care in the first place. We see it in every other area of economics—when people spend their own money, they’re more careful about it.
An HSA-first model rewards healthy behavior. If you take care of yourself, exercise regularly, don’t smoke, and manage chronic conditions responsibly, your HSA balance grows. That money is yours—to use for future healthcare needs, to pass on to family members, or potentially to roll into retirement accounts.
This isn’t about punishing sick people. Catastrophic coverage ensures nobody goes bankrupt from cancer or a car accident. But it does mean the guy who goes to the ER for a stubborn cold might think twice when he’s looking at a $150 HSA deduction versus waiting to see if it resolves on its own.
The Stability Factor
One underappreciated benefit of this model: it would dramatically reduce the job-lock problem and the chaos that happens when people change insurance carriers. Your HSA is yours—it doesn’t disappear when you change jobs. Your catastrophic coverage is simpler and more standardized, making transitions between carriers relatively painless.
No more worrying whether your new insurance will cover your existing medications. No more starting over with deductibles mid-year because you changed employers. No more being terrified to leave a job you hate because you might lose coverage for a pre-existing condition.
The current system creates enormous inefficiency as people churn through different insurance networks, requiring new referrals, establishing care with new providers, and navigating different formularies and coverage rules. A simpler system reduces this waste while giving people more freedom to make career moves without healthcare anxiety.
This Isn’t Radical—It’s Common Sense
Nothing about this proposal requires magical thinking. We’re not assuming people will suddenly become healthcare experts or that the free market will solve every problem. We’re simply saying:
- Providers should charge everyone the same fair price
- People should be able to afford routine healthcare out of pocket
- Insurance should function like actual insurance—protecting against catastrophic costs
- Those who take care of themselves should benefit from it
- Simpler systems with fewer middlemen cost less to operate
We’ve spent decades adding complexity to healthcare, convinced that more regulation, more insurance coverage, and more intervention would somehow make things better and cheaper. It hasn’t worked. Costs keep rising, satisfaction keeps falling, and most Americans are one serious illness away from financial disaster despite paying thousands in premiums every year.
Maybe it’s time to try something radically simple instead.
The infrastructure for this already exists. HSAs are established and popular. Catastrophic insurance policies exist. Providers already have negotiated rates—they just need to extend them to everyone. The main barriers aren’t technical or economic—they’re political and structural, involving entrenched interests that profit from the current complexity.
But the logic is undeniable. Give people transparent pricing, control over their healthcare dollars, and protection from true catastrophes. Trust them to make reasonable decisions about their own bodies and their own money. Cut out the administrative bloat that adds cost without adding value.
It won’t solve every problem in healthcare. But it would solve the affordability crisis for the vast majority of Americans—and that alone would be worth the disruption to the status quo.