Posted on 12/18/2025 8:05:59 PM PST by SeekAndFind
President Donald Trump has reopened the healthcare debate with a mix of ideas that do not align. He has pledged to “terminate” Obamacare, then signaled openness to extending ACA subsidies, then endorsed personal freedom accounts that would send money directly to individuals.
These proposals represent very different diagnoses of what is wrong with American health care. No serious reform effort can point in contradictory directions.
But this problem extends far beyond Trump.
Republicans have offered inconsistent signals, with some now willing to extend ACA subsidies again despite a decade of arguing – correctly – that these subsidies inflate premiums and entrench insurer dominance. Others want to preserve zero premium plans that simply shift costs onto taxpayers. Free-market analysts have warned that subsidy “compromises” are simply Obamacare under a new name.
Yet Democrats offer no better path.
Their answer to rising premiums and shrinking networks is the same solution they apply to every public-policy problem: more government. When their policies increase costs, they respond with even larger subsidies.
When regulation distorts markets, they impose more regulation. And when the system falters under its own weight, they insist the only answer is to socialize even more of it.
That approach has produced a decade of escalating prices and fewer choices, and expanding the model would only magnify the failures.
Trump’s strongest idea is his call to direct funds to individuals instead of insurers.
Washington has spent decades funneling billions into insurance companies, insulating them from risk and pushing the financial burden onto families. Giving consumers control over those dollars would force insurers to compete for business and bring price discipline into a system that has lacked it for half a century.
From an economic standpoint, incentive alignment is essential. Markets work when consumers – not administrators – drive demand and determine value.
But this idea cannot coexist with expanding subsidies. Increasing the size and scope of federal subsidies reinforces the very system that blocks market forces. You cannot fix a failing entitlement by enlarging it. Nor can you create competition when the government continues to dictate coverage rules, distort risk pools, and protect the largest incumbents.
Republicans and Democrats alike fall into this government-knows-best trap when they mistake subsidies for reform.
Americans now bear roughly $2 trillion in annual healthcare regulatory and transaction costs by governments, an economic burden that inflates prices long before care reaches the patient.
Regulation reduces competition, deters new entrants, and forces providers into costly compliance exercises that displace actual care. No reform effort will succeed until this regulatory weight is dramatically reduced.
Real reform requires structural change rooted in basic economics. Americans need broad, flexible personal accounts they manage directly. Policymakers must address the 70-year-old employer-sponsored insurance tax exclusion, which I analyze with Dr. Deane Waldman in our Empower Patients work.
This tax distortion hides the true cost of care, prevents families from choosing the plans they want, and undermines competition across the system. A genuine market cannot function on top of a tax regime designed in the 1940s.
Reform must also expand access to direct primary care, telehealth, and interstate competition while rolling back federal and state mandates that limit options and inflate premiums. These changes would open the door to innovation, lower prices, and restore patient-doctor relationships.
Neither party will achieve this outcome by preserving the architecture of Obamacare or doubling down on government control. Democrats promise more subsidies and more centralization. Republicans risk drifting into the same trap by entertaining policies that reinforce federal dominance. Both approaches will lead to higher costs, fewer choices, and deeper dysfunction. Trump’s instinct to expand patient control is a valuable starting point. His support for expanding subsidies moves in the opposite direction. The same is true for Democrats who insist that the answer to every failure is to give government even more power.
If America wants a functioning healthcare system, it must choose a path grounded in ownership, transparency, and competition supported by regulatory restraint. This is the only framework capable of lowering costs and increasing access without bankrupting taxpayers. Anything less guarantees more of the same.
100% agree. We have a once in a lifetime opportunity to rebalance the force of power between the individual and the Federal Government. Let’s dial the government back to an absolute minimum and make America great again!
“Markets work when consumers – not administrators – drive demand and determine value.”
HOSPITAL PATIENT AGREEMENT
....
Patient agrees to pay for the care received at the price at which it is billed.
Signature_____________ DATE___________
It’s not a simple matter to understand where Trump is taking things.
But I guess it’s just human nature to take things at face value, rather than trying to see the hidden parts.
RE: Patient agrees to pay for the care received at the price at which it is billed.
And if the Patient cannot pay for the care, tough luck.
“personal freedom accounts that would send money directly to individuals.”
Mr. Griffin, if you don’t have expensive tests done, I can’t do anything to help you.
ABC News recently and proudly showed a segment on how a family fought for and got an $800,000/year drug for their child.
“tough luck”
20-year lien on house, 18% interest, compounded
Share of total health spending, by percentile, 2021
Top 1% of people with the highest health spending 24%
Top 5% 51%
Top 10% 67%
Bottom 50% 3%
“people with health spending in the top 1% had average spending of $166,980 per year”
“Roughly 14% of the population had $0 in health expenditures in 2021”
About three million Americans are going to be in the top 1% ($166K+) in 2026.
Stuffing HSA accounts isn’t going to cover their bills.
There’s no substitute for insurance in the near term.
RE: 20-year lien on house, 18% interest, compounded
I’ve seen this happen to some people who aren’t poor enough for Medicaid, aren’t old enough for Medicare, and who decided to take the chance of not having health insurance ... until catastrophe struck.
I have an ideal solution to health insurance cost. I was a sick man in my mid-50’s. High blood pressure causing fainting spells, heart beats irregular, border line diabetic, hip joint pain, chest pains after eating a good meal, etc.
I quit the well paying job, since my employer would continue my health insurance at the low rate employees were paying. To kill time in retirement, I began playing golf at Orchard Hills country club in WA state which was cheap to join and low monthly dues. Me and wife could play unlimited golf for fixed monthly dues. Started playing 9 holes, then gradually upped to 18. After 3 months I was playing 19 holes 5 times every week. That amounts to walking 30 miles every week pushing my golf cart. To my shocking surprise, all of health issues disappeared in a year. Now at age 85 I require no doctor, no prescriptions, no pains, EKG is normal, A1C is below 5.8. I also read an article that regular exercise is a cancer preventer.
If every one starts a daily exercise program before age 50, 75-80% people will not require health insurance until age 65 when Medicare kicks in.
That is a distraction.
It is up to congress unfortunately. And the day when republicans have a supermajority are long gone. Unfortunately, I see the design failure of Obamacare as the silver bullet for a permanent democrat majority. People don’t care that it was created by the democrats. They see a $3000 a month insurance bill and $15,000 yearly deductible.
accounts allowing people to seek the medical care they would like ,not a mass processing system that doesn’t listen the patient, nor provide care with a whole body mindset instead of pieces parts focus, as if the body does not all work together as one, which at times causes more harm than good, by tinkering with one thing and chain reaction causes others.
I’ve got an unpopular opinion that’ll surely get me some flames from this group: allow people to opt out of Medicare and remove the HSA cap.
I’m in my 40s, but I would gladly opt out of Medicare to reinvest the money given to the Fed on my own in an HSA. I’ve been doing so for 20 years, and I have a pretty decent chunk of funds that I can pull from for medical expenses.
Those who are near or past retirement and already leveraging it can use Medicare until they die. Those who’ll likely never see a penny of it because it’s insolvent will have a nice investment nest egg to rely on for those expenses later in life.
Let’s be realistic: Obamacare is never going away. Camel is fully in the tent at this point.
“Republicans have offered inconsistent signals, with some now willing to extend ACA subsidies again despite a decade of arguing – correctly – that these subsidies inflate premiums and entrench insurer dominance. “
Four Republicans were willing to extend ACA subsidies. Regardless, they played FAFO.
Repeal the law which prohibits the reimportation of drugs.
Markedly increase the government cap on medical residences.
Relax the rules on what can be sold over the counter.
Hey, I’ve got an even better idea. How about personal accounts funded personally? Now we’d be starting to get somewhere...
They feel like they’d still have to cover your senior medical bills if you blew that money elsewhere sooner.
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