How to Become an Empowered Patient | TWE 165
What’s missing from the healthcare conversation? Patients.
Hello Friends!
Health policy is gaining momentum at both the state and federal levels. Leaders across the country, including President Trump, have discussed ways to put patients back in control of their healthcare dollars. Meanwhile, affordability concerns are pushing healthcare costs to the forefront as families, employers, and policymakers struggle under rising premiums and out-of-pocket expenses. Recently, I submitted written testimony to the Texas House Select Committee on Health Care Affordability as lawmakers examine the growing cost of care in the state.
In today’s episode of This Week’s Economy, we’ll explore why America spends more on healthcare than the entire economy of Germany, yet still leaves millions of patients frustrated, overcharged, and disconnected from their own care. We’ll also discuss how patient-centered reforms could restore transparency, strengthen the patient-doctor relationship, lower costs, and give Americans more freedom to make healthcare decisions that best fit their lives.
With the re-release of Become an Empowered Patient, my book with Dr. Deane Waldman, this is an important time to revisit what real patient-centered healthcare reform could look like.
Catch the full episode on YouTube, Apple Podcast, or Spotify, and visit my website for more information about Ginn Economic Consulting.
1. Our Health Care System is Sick
The Principles:
Americans do not need another study to know healthcare is broken. They live it every month through rising premiums, higher deductibles, surprise bills, delayed care, shrinking physician independence, and wages squeezed by employer-sponsored coverage. They see a system with more “coverage” but less affordability, less transparency, and less trust.
Even today’s healthcare savings tools—HSAs, FSAs, and MSAs—are fragmented, confusing, and arbitrarily restricted. Some come with “use-it-or-lose-it” rules. Others are tied to specific insurance plans or limited by IRS, state, or employer restrictions. Instead of empowering patients, the system often limits flexibility and discourages smarter healthcare spending.
Why it Matters:
Outdated Rules Still Call the Shots:
Today’s distorted healthcare market traces back to World War II-era wage and price controls. Employers began offering health insurance to attract workers without violating flawed federal wage freezes, and the tax code rewarded that shift by favoring employer-sponsored coverage.
Even after most of those controls ended, the tax preference remained. Instead of workers receiving those dollars directly in their paychecks and choosing how to spend them, employers continued directing compensation into insurance premiums. Over time, this contributed to a system where health insurance became tied to employment and patients became increasingly disconnected from their own healthcare decisions.
A Three Party Market:
The fundamental problem with healthcare is that it does not operate like a normal market. In most markets, consumers make decisions based on price, quality, and value. In healthcare, those incentives are heavily distorted as it operates as a three-party system: the patient receives the care but often is not the direct payer, the provider rarely receives the listed price, and a third party—whether an insurer or government program—controls payment decisions. That third party determines what will be covered, how much will be paid, when payment occurs, and sometimes whether payment happens at all.
The major sources of money flowing into this system are employers, taxpayers, and Medicare premium payers, not patients directly. As a result, patients often lack both price transparency and meaningful control over their care.
Coverage is not the Same as Care:
One of the biggest mistakes in health policy is treating coverage and care as if they are the same thing. An insurance card does not automatically mean better access, lower costs, or stronger health outcomes. When patients are disconnected from real prices, doctors are buried under compliance burdens, and payment flows through layers of insurers and government programs, healthcare becomes more expensive, less personal, and harder to access.
Related Viewing: My conversation with Joe Grogan provides helpful background on the evolution of U.S. healthcare policy.
2. What is this Costing You?
The Principle:
America has the most expensive healthcare system in the world, costing $5.3 trillion annually, or almost $15,000 per person.
Yet despite that staggering price tag, millions of Americans still struggle to access basic care. Routine procedures are delayed for months, providers are buried in bureaucracy, and even insured patients often feel powerless and frustrated. If healthcare is supposed to help people heal, the current system is falling short.
Why it Matters:
Premiums are Rising:
Millions of Americans are seeing premiums and out-of-pocket costs rise year after year. Under current law, premium assistance is tied to the cost of a government-defined benchmark plan. Consumers never actually receive those dollars directly. Instead, the federal government sends subsidy payments straight to insurance companies each month, with payments automatically increasing as premiums rise. This structure disconnects consumers from the true cost of coverage while rewarding a system where higher premiums often lead to larger subsidy payments.
You’re Buried in BURRDEN Costs:
Of the $5.3 trillion annually spent on health care, 31% to 50% is wasted on non-clinical overhead. Never reaching patient care, this money is consumed by what we call BURRDEN:
Bureaucracy
Unnecessary rules
Regulations
Red tape
Directives
Enforcement mandates
Noncompliance costs
Doctors and hospitals spend enormous amounts of time and money navigating payment systems, reporting requirements, prior authorizations, and government mandates instead of focusing on patients.
Compensation You Cannot Control:
Many Americans view employer-sponsored insurance as a generous workplace benefit. But in reality, it is compensation that workers largely cannot control.
Roughly 165 million Americans rely on employer-sponsored insurance, yet most workers face limited, one-size-fits-all options chosen by their employer. Businesses now spend tens of thousands of dollars per employee on family coverage through tax-advantaged health plans. This reinforces a system with less choice, weaker competition, and rising healthcare costs hidden from workers’ paychecks.
Related Reading: Learn more about the financial costs and structural problems within America’s healthcare system in this report for Americans for Tax Reform.
3. The Policy Cure
The Principle:
No-Limit Health Savings Accounts (NLHSAs) would replace today’s patchwork of healthcare savings tools with one simple, flexible option. Unlike current HSAs, FSAs, and MSAs, NLHSAs would allow unlimited tax-free contributions, eliminate “use-it-or-lose-it” rules, remain transferable across family members and generations, and cover any medical care patients deem necessary.
Instead of forcing Americans to navigate a maze of restrictions and government rules, NLHSAs would put patients back in control of their healthcare dollars. And it would save billions of dollars spent on unnecessary regulatory BURRDEN.
Why it Matters:
Restoring Patient-Doctor Relationship:
The healthcare debate should shift away from the question, “How do we expand bureaucratic coverage?” and toward a better question: “How do we restore the patient-doctor relationship and allow markets to work again?” NLHSAs help accomplish this by giving patients direct control over healthcare spending. Rather than routing decisions through layers of insurers, employers, and government programs, patients would decide how and where to spend their own healthcare dollars.
Why NLHSAs Work:
NLHSAs encourage competition, innovation, and price transparency throughout the healthcare system. Insurers must compete for consumers by offering affordable and flexible plans people actually want, including catastrophic coverage and short-term options. Doctors and healthcare facilities compete for patients based on price, quality, and service instead of navigating bureaucratic payment systems. Providers have stronger incentives to publish transparent pricing, improve outcomes, and deliver care more efficiently because patients would control the dollars.
Where it’s Already Working:
We already see examples of these principles working today through direct primary care (DPC), cash-pay surgery centers, and other patient-centered models. When patients spend healthcare dollars directly, prices often fall, transparency improves, and service becomes faster and more responsive. Patients gain greater freedom to choose the care that works best for them instead of relying on insurers, employers, or government bureaucracies to make those decisions.
Related Reading:I explain how states like Texas can pursue patient-centered healthcare reforms in a recent piece.
4. How Empowered Patient Accounts Benefit You
The Principle:
Employer-sponsored insurance distorts the healthcare market and inflates costs. It encourages overinsurance, limits individual choice, and suppresses competition.
In a true market, people would shop for health coverage like they do other products and services—based on value, price, quality, and personal needs. Insurance should exist to protect against major financial risk, not to micromanage routine medical decisions or dictate patient care.
Why it Matters:
Lower Prices, Better Quality:
When patients control their healthcare dollars, they become informed and value-conscious consumers. That creates stronger competition, which helps lower prices and improve quality. Patients gain the ability to choose providers, compare options, and spend healthcare dollars where they receive the best value and service.
What This Looks Like in Real Life:
A consumer-driven system rewards providers that offer affordable, transparent, and high-quality care while giving patients greater freedom and flexibility. If families controlled more of their healthcare spending directly, they could:
Choose coverage that fits their actual needs instead of one-size-fits-all employer plans
Use direct-pay doctors, cash-based clinics, and transparent pricing options
Keep more of their earnings rather than subsidizing inefficiency hidden throughout the system
Avoid restrictive provider networks that limit access to care
Build long-term healthcare savings they can carry across jobs and life stages
Doctors Can Focus on Patients Again:
In this model, doctors would spend less time navigating insurance mandates, prior authorizations, and pharmacy benefit managers — and more time caring for patients. Instead of practicing medicine around bureaucratic rules, physicians could focus on what is best for the individual sitting in front of them. Patients would gain more time with their doctors, stronger relationships, and care tailored to their needs rather than dictated by insurance paperwork. That means happier patients and physicians who remember why they became doctors.
Related Reading: Learn more about becoming an empowered patient in Become an Empowered Patient, co-authored with Dr. Deane Waldman.
Bottom Line
When it comes to healthcare, America has an incentives problem. The system rewards bureaucracy over patients, third-party control over personal responsibility, and complexity over transparency.
We cannot continue attempts to solve these failures by adding more regulations, subsidies, and centralized control, yet costs continue to rise while trust continues to fall. Real reform means restoring incentives that put patients, doctors, and competition back at the center of healthcare.
Empowered Patient Accounts and No-Limit Health Savings Accounts offer a path toward a more affordable, transparent, and patient-centered system where individuals control more of their healthcare dollars, and markets begin working again.
Healthcare should empower people. The goal should not simply be more coverage, but better care, lower costs, and policies that truly let people prosper.
For policymakers, I laid out an implementation plan in a recent episode of This Week’s Economy. Check it out if you’d like a step-by-step guide.
And don’t miss my discussion with my co-author, friend, and mentor, Dr. Deane Waldman. Contact me if you’d like to request a copy of our book, or purchase it here. Get involved in the Empower Patients movement here. Thanks!
Thanks for joining me in this episode of "This Week's Economy." For more insights, visit vanceginn.com and get even greater value with a paid subscription to my Substack newsletter at vanceginn.substack.com.
God bless you, and let people prosper!
