A new bipartisan bill seeks to break up vertically integrated health giants, but simply forcing breakups risks losing coordination and scale benefits. To the extent that consolidation is a problem, it is largely a product of regulation that shields big systems from competition. The real cure is deregulation: level payments, repeal CON laws, and empower consumers to drive competition.
Vermont Senate Bill 142 creates a pathway for foreign-trained physicians to seek a license to practice medicine in the state without having to repeat their residency training. The bill addresses a real workforce shortage, removes an unnecessary barrier to practice, respects the qualifications of trained professionals, and expands healthcare access for Vermonters.
The American health care system suffers from many misalignments of incentives, but one is particularly irksome: When individual patients make prudent decisions about their care, choosing reasonable but less costly alternatives, they capture none of the savings they generate. There are changes that can fix this disconnect between individual choice and individual benefit.
The recent ACA subsidy deadline briefly opened space for free-market reforms, but momentum for those ideas faded, as they have done many times in the past. Often, advocates for markets focus on the inefficiencies or waste associated with government-run healthcare. But that risks implying that if only government were more competent, it should run healthcare. The real case is moral. Health is a personal value that requires freedom.
An ER doctor dreams of running a tiny cash-pay urgent care in her apartment building, but federal rules force physicians to choose between Medicare and private pay. The ban on parallel practice blocks simple, low-cost help and pushes neighbors to crowded hospitals. A site-based reform, modeled on what is allowed elsewhere in the UK and Singapore, could expand choice and cut waste. Patients gain time and dignity.
Outdated and misguided all-payer rules prevent direct-pay healthcare models from expanding beyond primary care in the state of New Hampshire. Allowing cash-only surgical, imaging, and specialty facilities would increase patient choice, improve price transparency, and lower costs by avoiding hospital facility fees and insurance-driven complexity.
President Trump's Great Healthcare Plan proposes redirecting ACA subsidies into individual Health Savings Accounts, putting spending power directly in patients' hands. The idea raises big questions about who can use HSAs today, who is excluded, and whether broader, more flexible accounts could shift healthcare toward real consumer choice and long-term saving.
Most health policy debates skip past the question of goals and dive straight into mechanisms. But the debate itself rests on unexamined premises that favor government control. A better approach starts with a different goal: a society where individuals can pursue health as an active, personal project. Freedom and free markets are the moral and practical means to achieve it.
Medicine has long treated markets as morally suspect, teaching doctors to ignore costs and view profit as corrupting. This anti-market ethos, not economics or political preferences, explains the resistance to free-market health policy. When profit is earned through honest exchange, markets can reward integrity and better serve patients.
In this survey, we ask a diverse range of respondents to predict the likelihood of 28 different potential developments in U.S. health policy over the next five years. The propositions spanned a wide landscape of issues, from national spending trends and insurance reforms to the growth of direct-to-consumer care models and evolving state and federal policies on drug use and access to services.
In most sectors of the American economy, we celebrate the moment when insiders break away to build something better. Engineers start their own firms. Chefs open their own restaurants. Innovators leave incumbents and test their mettle in the market. Only in US healthcare do we treat that entrepreneurial impulse as a threat worthy of prohibition. It is time to rethink the soft ban on physician-owned hospitals.
The rules against self-referral are not just offensive to physicians; they are complex and arbitrary. They create non-trivial compliance costs and they chill innovation in how medical practices might be organized and run more efficiently. Self-referral is not an inherently pernicious business practice. It’s the medical equivalent of vertical integration in the business world.
