Escaping the Sick-Care Trap: A Blueprint to Cut US Healthcare Costs in Half

The United States spends nearly 18% of its GDP on healthcare—roughly $4.5 trillion annually—yet ranks poorly among developed nations in life expectancy and chronic disease outcomes. We do not have a healthcare system; we have a "sick-care" administration system, burdened by layers of bureaucracy, artificial scarcity, cartel-like pricing, and a failure to address the root causes of illness, all driven by artificial regulations and misaligned incentives that collectively break the entire system.

Tinkering around the edges will not fix this. Achieving a dramatic reduction in costs—cutting expenses and premiums by 50% while improving access—requires a synchronized blitzkrieg of policy reforms. We must simultaneously unleash free-market competition, eliminate administrative waste and fraud, end price-gaming schemes, restore clinical freedom, and, most critically, shift the paradigm from managing chronic disease to cultivating metabolic health.

Repeal "Certificate of Need" (CON) Laws

Thirty-plus states still maintain CON laws, which require healthcare providers to prove to a government board that a new hospital, MRI machine, or surgery center is "needed" before they can build it. This is protectionism for incumbent hospital systems. These laws raise per-patient costs, limit access, and are associated with worse outcomes in some cases. They block new ambulatory surgery centers, imaging clinics, urgent-care centers, and small hospitals that would otherwise compete on price and convenience. Repealing CON laws nationwide would spur the construction of new facilities, create more local healthcare options, and put downward pressure on prices through actual competition instead of government-protected monopolies.

Create a National Market for Insurance

Currently, selling insurance across state lines is logistically difficult due to a patchwork of 50 separate regulatory environments. This balkanization creates local monopolies where one or two insurers dominate a state and can quietly raise premiums and administrative overhead without fear of losing customers. Instead, we should implement "Health Care Choice Compacts" that allow insurers to sell plans nationally under one primary set of regulations and solvency standards. That breaks local monopolies and forces large carriers to compete on price, network efficiency, and real value instead of exploiting regulatory silos. Over time, a national market compresses the “net cost of insurance” line item—the administrative and underwriting overhead that now absorbs a massive share of every premium dollar.

Accelerate and Expand the Provider Workforce

We face a shortage of primary care physicians, driven by the excessive cost and time required for medical education and by policies that reward high-margin specialties over community-based primary care. We should incentivize a 3-year medical degree track for primary care tied to lower tuition and service commitments, cutting debt burdens and pulling doctors into practice sooner. We should nationalize "Assistant Physician" laws, like Missouri’s model, allowing unmatched medical school graduates to practice primary care under supervision in shortage areas instead of letting their training go unused. At the same time, we should relax unnecessary scope-of-practice restrictions on nurse practitioners and physician assistants so they can practice to the top of their license, especially in primary care, urgent care, and rural settings. These changes together inject tens of thousands of additional clinicians into the system, expand access, shorten wait times, and lessen reliance on expensive ERs and hospital systems for basic care.

Federal Tort Reform

Doctors practice "defensive medicine"—ordering marginal CT scans, lab tests, and referrals—not primarily to help the patient, but to protect themselves from lawsuits. Under current rules, that behavior is rational for the individual physician and irrational for the system. We need federal caps on non-economic damages (such as "pain and suffering"), fair-share liability standards, and specialized health courts that resolve disputes faster and more consistently. This reduces the incentive to over-order low-value tests purely for legal cover. Direct savings show up as lower malpractice premiums and fewer frivolous suits, but the real prize is a large, ongoing reduction in unnecessary testing and procedures that add cost without improving outcomes.

Fix the Broken "Standard of Care" Regime

The problem is not just lawsuits after the fact; it is the way “Standard of Care” has been weaponized in advance to control what doctors are allowed to say and do. In theory it means what a reasonably careful clinician would do under similar circumstances; in practice it has been captured by large hospital systems, insurers, and guideline-writing committees heavily influenced by industry and regulators. Physicians are increasingly treated as employees whose job is to follow checklists, formularies, and corporate protocols—not to use their judgment for the human being in front of them. A doctor who wants to recommend aggressive lifestyle intervention, an off-label inexpensive generic, or an emerging therapy supported by real evidence but not yet stamped into guidelines risks reprimands, blocked orders, hostile peer review, loss of hospital privileges, contract termination, or being portrayed as “outside the standard of care” in court, so the safest career move is to do what the system expects even when it is more expensive, less effective, and misaligned with that patient’s needs. This regime locks in status-quo, high-cost care, blocks innovation at the bedside, silences honest conversations about diet and metabolic health, and steers patients toward expensive, guideline-blessed drugs and procedures even when cheaper, lower-risk options are available. We should allow explicit, documented “informed deviation from standard of care,” where physician and patient jointly agree on a reasonable, evidence-informed alternative when standard protocols fail, are unaffordable, or clash with patient values; create legal safe harbors for individualized, well-documented care rooted in rational risk–benefit analysis; separate licensure and discipline from mere protocol noncompliance so regulators target incompetence, fraud, and gross negligence—not independent thinking; and shift liability toward institutions that block beneficial care, making hospitals and insurers share responsibility when they prohibit metabolically sound interventions, off-label generics, or deprescribing harmful drugs. Freeing doctors to practice actual medicine instead of bureaucratic guideline enforcement would unleash a wave of low-cost, high-impact care—earlier metabolic intervention, rational deprescribing, smarter use of older generics, and treatment strategies tailored to individual biology rather than averaged trial populations—improving outcomes and cutting costs without a single new drug or device.

Repeal ACA Mandates and Restore Risk Pools

The Affordable Care Act mandated that all insurance plans carry a wide array of "Essential Health Benefits" (like maternity coverage for a 60-year-old male) and restricted “community rating,” forcing young, healthy people to heavily subsidize older, sicker populations directly through premiums. Predictably, premiums for the young skyrocketed, driving them out of the market and destabilizing risk pools. We need to allow the sale of affordable, à la carte, and "catastrophic-only" plans, including indemnity-style products and high-deductible coverage that pairs with cash-pay primary care. A healthy 25-year-old should be free to purchase a simple catastrophic plan rather than a gold-plated policy loaded with mandated benefits they neither want nor need. This could reduce premiums for young and healthy demographics by 50–60%, draw them back into the pool, and stabilize the market while using targeted, transparent subsidies for those who truly lack the means.

Drug Pricing and PBM Transparency

The pharmaceutical supply chain is opaque by design. Pharmacy Benefit Managers (PBMs) act as middlemen, negotiating rebates and fees from drugmakers that they often keep, rather than passing them on to consumers or plan sponsors. Drug companies, meanwhile, use “patent thickets” and “pay-for-delay” deals to prevent cheap generics from entering the market. We should mandate PBM transparency, ban “spread pricing” where PBMs upcharge plans relative to what they pay pharmacies, and require pass-through of rebates at the point of sale or to the employer/plan sponsor. At the same time, we must tighten patent standards to prevent cosmetic evergreening and aggressively end pay-for-delay schemes. When genuine generics enter the market, prices for a given drug class commonly fall by 30% to 80% within a few years. Applied to a drug market that now includes extremely expensive chronic-disease and weight-loss medications, even moderate reforms here translate into tens of billions in annual savings without denying anyone needed therapy.

Confronting the Toxic Food Environment (Seed Oils, Sugar, Ultra-Processing, and Ingredient Creep)

This is the highest-leverage long-term reform. Chronic metabolic diseases—type 2 diabetes, heart disease, stroke, fatty liver disease, and obesity—drive the majority of healthcare spending. Obesity alone is estimated to cost the healthcare system nearly $173 billion a year, and that ignores the broader impact on productivity and disability. These conditions are tightly linked to modern diet: ultra-processed foods packed with refined carbohydrates, industrial seed oils (soybean, canola, corn oil), and synthetic additives. To reverse the trend, we should end agricultural subsidies that make corn, soy, and their derivative seed oils artificially cheap relative to whole foods; phase out petroleum-based artificial food dyes and the worst toxic additives; and require clear metabolic-risk labeling on highly processed products. But it is not just about banning the worst offenders; it is about actively privileging real food. Policy should explicitly favor whole and minimally processed foods with short, understandable ingredient lists—meat, eggs, fish, dairy, vegetables, fruits, nuts, and simple single-ingredient pantry staples—over products engineered in factories. That means aligning farm policy, school lunch standards, SNAP and WIC rules, and institutional procurement so taxpayer dollars flow first to foods with few ingredients and minimal processing, not to shelf-stable, seed-oil-laden, sugar-loaded products with ingredient lists that read like chemistry exams. It means letting employers, insurers, and HSAs directly subsidize these whole-food options, metabolic reset programs, and cooking education instead of only paying for drugs and procedures. A modest nationwide shift away from ultra-processed foods and toward minimally processed, ingredient-sane diets will drive down average BMI, insulin resistance, and inflammatory burden, which in turn drives down long-term healthcare costs. Removing the dietary drivers of metabolic inflammation—while actively rewarding simple, whole-food eating patterns—is the only way to turn off the chronic-disease tap rather than endlessly paying to mop up the damage.

Mainstream Direct Primary Care (DPC) and Real Price Transparency

We should not use insurance for routine primary care any more than we use car insurance for oil changes. The administrative burden of billing insurance for a $100 visit—coding, claims, prior authorizations, denials, and resubmissions—can cost almost as much as the visit itself. Administrative expenses, broadly defined, consume a staggering share of U.S. health spending. We should change IRS rules to allow Health Savings Accounts (HSAs) to pay for Direct Primary Care memberships and bundled cash-pay primary care and urgent care. In the DPC model, patients pay a predictable monthly fee directly to a doctor or small practice for comprehensive primary care and easy access, bypassing the insurer entirely for most routine needs. Real-world DPC programs show large reductions in ER visits, hospital admissions, and downstream specialist and surgical utilization because issues are managed early by a doctor who knows the patient well. At the same time, we should enforce real hospital and clinic “cash price” transparency, with meaningful penalties for non-compliance and simple, consumer-facing tools to compare prices for common services. When people can see prices and pay directly for routine care, both utilization patterns and provider behavior change.

End Facility-Fee Gaming with Site-Neutral Payments

Hospitals increasingly buy up independent physician practices, then rebrand them as “hospital outpatient departments.” With the stroke of a pen, the exact same service in the exact same building—an office visit, EKG, or infusion—suddenly carries a much higher “facility fee” just because it is technically part of a hospital. This is pure billing arbitrage, not improved care. Medicare and commercial plans should move to site-neutral payment policies: the same service at the same level of complexity should be paid at roughly the same rate whether it is performed in an independent office or a hospital-owned clinic, with narrow exceptions for truly higher-acuity hospital settings. Eliminating facility-fee inflation cuts costs directly and also slows the wave of hospital consolidation whose primary financial rationale is exploiting this payment gap. The savings here are enormous over a decade, with no reduction in real access or quality.

Slash Administrative Overhead and Billing Complexity

The United States spends an extraordinary share of its health budget on paperwork, coding, prior authorizations, and fragmented IT rather than on actual care. Administrative expenses and billing complexity soak up hundreds of billions of dollars every year. A serious simplification push would standardize and drastically limit prior-authorization requirements for common procedures and drugs, especially for providers with proven low denial rates. It would mandate simpler, uniform claim formats and code sets across public and private payers, instead of a Byzantine matrix that forces providers to maintain large back-office coding armies. It would also enforce true interoperability of electronic health records so that data follows the patient without endless faxing, manual re-entry, and duplicative testing. Even a partial success here safely eliminates a quarter-trillion dollars or more in waste annually without cutting a single clinically valuable service.

Attack Fraud, Waste, and Improper Payments at Scale

Healthcare fraud and improper payments are not rounding errors; they are a structural feature of huge, opaque programs and contracts. Government reports routinely estimate well over $100 billion per year in improper payments in major programs alone, and large criminal fraud schemes are regularly uncovered in the billions. A serious response would use modern data analytics and identity verification to flag upcoding, phantom billing, and suspicious utilization patterns in real time; shift high-risk segments into payment models where providers share downside risk for cost overruns, making fraud and blatant overuse unprofitable; and tighten eligibility and provider-enrollment controls to prevent payments to fake entities or ineligible providers. Every percentage point reduction in fraud and improper payments in a multi-trillion-dollar system represents tens of billions of dollars that can be redirected from criminals and waste back to real patient care or premium relief.

Conclusion

When combined, these changes create a powerful compounding effect that can realistically deliver a 50% reduction in effective healthcare spending in the United States. Repealing CON laws and opening a national insurance market increases competition and crushes local monopolies. Tort reform trims defensive medicine. Fixing the broken “Standard of Care” regime restores clinical freedom so doctors can recommend what actually works instead of what is bureaucratically safest. Drug and PBM reforms, site-neutral payments, and real price transparency slash unit prices on drugs, procedures, and hospital-based services. Direct primary care and cash pricing strip out a huge chunk of primary care administrative overhead while improving access and outcomes. Administrative simplification and aggressive anti-fraud efforts remove hundreds of billions in pure waste and abuse. Most importantly, confronting the toxic food environment and prioritizing metabolic health reduces the incidence and severity of the chronic diseases that drive the majority of healthcare costs.

If you remove roughly 40% of administrative overhead from primary care via DPC and cash-pay models, reduce unnecessary testing and procedures by even 10% through tort reform, standardized utilization rules, and restored physician autonomy, slash drug and facility-based prices by 20–40% through patent, PBM, and site-neutral reforms, cut administrative and billing waste by a quarter-trillion dollars or more, and reduce the burden of chronic metabolic disease by 20% or more by removing toxic food inputs and aligning incentives with actual health, the math leads to a system that costs radically less than what we have today while delivering better access and outcomes.

By ceasing to subsidize sickness, bureaucracy, price gaming, and protocol-enforced mediocrity—and instead incentivizing competition, efficiency, clinical freedom, and genuine health—a 50% reduction in the national healthcare burden is not only possible; it is imperative.