Voters are complaining about the wrong thing. Every election cycle, the "affordability" trope gets dragged out like a tired stage prop. We hear the same choir of grievances: premiums are too high, insulin costs more than a used sedan, and the middle class is one broken leg away from bankruptcy. The competitor's narrative—and the one you likely believe—is that we have a "cost" problem.
That is a lie. We have a consumption problem masquerading as a financial crisis. Meanwhile, you can find similar stories here: The Estrogen Patch Shortage is a Manufactured Crisis of Medical Timidity.
When people cry about affordability, they are usually demanding a way to consume infinite resources with zero personal friction. They want the most advanced medical technology on the planet, delivered instantly, with no out-of-pocket cost. In any other sector of the economy, we call that a fantasy. In health care, we call it a right. By focusing on the price tag, we’ve ignored the fact that the "product" we are buying is a bloated, inefficient system designed to treat symptoms rather than outcomes.
The Insurance Hallucination
The biggest barrier to fixing health care is the collective delusion that "insurance" should pay for everything. I’ve watched health systems burn through billions in administrative overhead just to process $50 claims for routine check-ups. It’s madness. To see the complete picture, check out the detailed analysis by WebMD.
Insurance is meant for catastrophe. It’s for the house burning down or the stage four diagnosis. When we forced insurance to cover "wellness visits," birth control, and cold symptoms, we didn’t make health care cheaper. We just hid the cost behind a curtain of bureaucracy and then acted surprised when the premiums spiked to cover the paperwork.
Imagine if your car insurance covered oil changes, car washes, and gasoline. Your monthly premium would be $2,000, and you’d spend three hours at the gas station waiting for "prior authorization" from an adjuster. That is exactly what we have done to medicine. By removing the consumer from the price discovery process, we killed the only mechanism—competition—that actually drives prices down.
The Myth of the "Greedy" Pharma Villain
It’s easy to point at a CEO in a suit and scream about "price gouging." It makes for a great 30-second campaign ad. But it’s a lazy critique.
The reality? The high cost of drugs isn't just about corporate margins; it’s about a regulatory blockade that makes it nearly impossible for anyone but a titan to enter the market. When it costs over $2.6 billion to bring a single drug to market—according to the Tufts Center for the Study of Drug Development—you aren't looking at "greed." You’re looking at a government-sanctioned monopoly.
If you want cheaper drugs, you don't need price controls. Price controls lead to shortages and a total halt in innovation. You need to dismantle the FDA’s sclerotic approval process. We have created a "Landscape of Safety" (to use a term I despise, but let’s call it a Safety Trap) that is so risk-averse it’s actually killing people by proxy. Every year a life-saving therapy sits in a filing cabinet waiting for a bureaucrat's stamp is a year of lost lives.
Stop asking why the drug costs $100,000. Ask why the government made it illegal for anyone else to make it for $500.
Your Health is a Personal Liability, Not a Public Utility
Here is the truth nobody wants to hear: A massive portion of the "affordability" crisis is driven by lifestyle choices that we refuse to tax or penalize. We treat health care like a public utility, but we treat our bodies like high-performance vehicles that we can run into a wall and expect a free repair.
- Chronic Disease: Type 2 diabetes and heart disease drive the vast majority of spending. Most of this is preventable.
- The Subsidy Loop: We subsidize corn syrup with one hand and then subsidize the insulin to treat the resulting diabetes with the other.
- Moral Hazard: If you know the "system" will pick up the tab for your bypass surgery, there is zero financial incentive to stop eating the things that cause the blockage.
We don't need "Medicare for All." We need "Accountability for All." Until we link personal behavior to financial outcomes, the system will remain a bottomless pit. If you want to talk about affordability, let’s talk about why the person running five miles a day pays the same premium as the person smoking a pack a day. The current model is a massive wealth transfer from the disciplined to the undisciplined.
The Hospital Industrial Complex
While everyone is distracted by pharma, the real thieves are the hospital systems. These "non-profit" behemoths have spent the last decade gobbling up independent physician practices. They aren't doing it to "improve care coordination." They’re doing it to gain market leverage.
When a hospital owns every doctor in town, they can dictate prices to the insurers. This is horizontal integration at its most predatory. I’ve seen bills where a simple saline bag—which costs about $1 to manufacture—is billed at $700. Why? Because they can.
Voters aren’t worried about affordability; they are victims of a cartel. But instead of breaking up the cartel, they are asking the government to become the cartel's primary customer. Single-payer is not a solution; it’s a surrender. It’s telling the hospital systems, "Keep your $700 saline bags; we’ll just use taxpayer money to pay for them."
Stop Trying to "Fix" the System
The status quo is not "broken." It is functioning exactly as it was designed: to maximize billable hours and minimize risk for administrators.
If you actually want to lower costs, you have to embrace the things that make people uncomfortable:
- Price Transparency: Not a "good faith estimate," but a menu. If a surgery center can't tell you the price of a hip replacement upfront, they shouldn't be allowed to perform it.
- Direct Primary Care: Bypass the insurance middleman. Pay your doctor $80 a month for unlimited access. It’s already happening, and it’s thriving because it cuts out the 40% of health care spending that goes toward "administration."
- End the Employer Link: The fact that your health care is tied to your job is a relic of World War II wage freezes. It’s a historical accident that turned into a cage. It kills labor mobility and keeps you trapped in a plan you didn't choose.
The Brutal Reality of Rationing
Everyone is terrified of the word "rationing." Newsflash: We already ration care. We just do it through "denial of coverage" and "out-of-network" traps.
The contrarian truth is that we need to ration care, but we need to do it honestly. We cannot provide every 95-year-old with a $200,000 experimental heart valve and still expect to have a functioning economy. That sounds cold, but math doesn't have a heartbeat. By pretending we can do everything for everyone, we end up doing everything poorly for everyone.
We are currently spending 18% of our GDP on health care. Other developed nations spend 10-12%. They don't have better outcomes because they have better "coverage." They have better outcomes because they don't treat every minor ailment like an emergency and they don't over-medicalize the end of life.
The Payer is the Problem
The moment a third party (government or insurance) pays for a service, the price of that service stops reflecting reality. If you want health care to be affordable, you have to make the patient the payer again.
This doesn't mean the poor should suffer. It means we should give the poor cash or health savings accounts, not a "plan" that they can't understand. Put the power back in the hands of the individual. When people shop with their own money, prices drop. When people shop with "the government's money," prices skyrocket.
Stop voting for "affordability" and start voting for disruption. If a politician promises to make your insurance cheaper without dismantling the hospital-pharma-insurance triad, they are lying to you. They aren't fixing the system; they’re just rearranging the deck chairs on a sinking ship while the band plays "Single Payer" on repeat.
Tear it down. Start over. Buy your health care like you buy your groceries: with a clear price, a choice of providers, and the freedom to walk away from a bad deal.
