By Coach Manny A.
The Problem No One Wants to Talk About
Healthcare in the U.S. is expensive—not because we lack great doctors, facilities, or technology—but because the business model itself is designed to keep prices high and patients confused.
Right now, hospitals and insurance companies play a game where neither side is incentivized to lower costs—and the patient always loses.
But what if we stopped trying to “patch” the system with more rules and just changed the way insurance and hospitals operate altogether?
Here’s how we fix it.
Why Healthcare Costs Are So High (The Insurance-Hospital Game)
Most people don’t realize that hospitals and insurance companies actually work together—not against each other—to keep costs inflated.
Here’s how it works:
- Hospitals set absurdly high “sticker prices.”
- This is why you see a $15 Tylenol, a $3,000 ER visit for stitches, or a $40,000 hospital bill.
- But almost no one actually pays these prices.
- Insurance companies “negotiate discounts” off these fake prices.
- A hospital might bill $50,000 for a surgery, but an insurance company “negotiates” it down to $10,000 and calls it a win.
- You think your insurance just saved you money—but in reality, the real price was never supposed to be $50,000 in the first place.
- Hospitals benefit because they get to charge different prices to different payers.
- Uninsured people get screwed the hardest because they get charged full price.
- Insurance companies win because they can justify higher premiums by “saving” you from inflated costs.
- The only loser? You.
The whole system is built on hidden pricing, fake discounts, and middlemen making money off confusion.
If we want real change, we need two things:
- Non-profit insurance that actually exists to cover care—not make money.
- Transparent hospital pricing so people know what they’re paying before they get treated.
Why Healthcare Is the Exception to the Free Market
I’m pro-capitalism because, in most industries, profit drives competition, innovation, and efficiency.
But healthcare is different.
In most industries, the people creating products or services are entrepreneurs taking financial risks to innovate and improve. But in healthcare:
- Doctors don’t make more money when hospitals overcharge you.
- Surgeons don’t negotiate deals with insurance companies.
- Researchers aren’t designing new medical technology based on how much they can charge for it.
Most healthcare workers aren’t risk-takers—they’re highly trained professionals who prioritize stability. Unlike in industries like tech, real estate, or finance, there’s no financial incentive for them to maximize profits at your expense.
Instead, the people controlling pricing and costs are middlemen—insurance executives and hospital administrators—who profit off confusion.
That’s why letting hospitals and insurance companies operate like profit-driven businesses doesn’t lead to better care—it just leads to more expensive care.
The Solution: Non-Profit Insurance & Transparent Pricing
1. Insurance Shouldn’t Be a Business
Insurance should function like a safety net, not an investment vehicle. Instead of answering to shareholders, all health insurers should be non-profit so that:
- Premiums actually go toward medical care, not corporate bonuses.
- Claims are paid out fairly, rather than denied to protect profit margins.
- There’s no incentive to inflate costs because there’s no reason to “maximize revenue” when revenue only exists to cover expenses.
This doesn’t mean insurance disappears—it means it operates the way it was originally intended.
2. Hospitals Must Show Prices Upfront
Right now, no one knows what anything costs because hospitals negotiate secret rates with insurers.
- One person gets charged $500 for an MRI, while another pays $5,000 for the exact same scan.
- A hospital charges $12 for a single ibuprofen pill—because they can.
- Patients can’t “shop around” because prices are hidden on purpose.
If all hospitals had to list prices upfront, like a restaurant menu, it would:
- Force hospitals to compete on price and quality.
- Eliminate hidden markups that gouge patients.
- Let people make informed choices before they receive care.
How Do We Phase This In? (Because Change Won’t Happen Overnight)
Shutting down for-profit insurance and forcing hospitals to be transparent can’t happen in one day—but it can happen in stages:
Step 1: Enforce Existing Price Transparency Laws
- Hospitals are already supposed to publish their prices under current laws—but most ignore it because there’s no enforcement.
- The first step is cracking down on non-compliance and making it standard practice.
Step 2: Incentivize Non-Profit Insurance
- Instead of outright banning for-profit insurance, start by giving major tax breaks and funding support to non-profit insurers.
- The goal is to let the market shift naturally—as people see the benefits of non-profit models, they’ll move away from for-profit plans on their own.
Step 3: Remove the Insurance-Hospital Negotiation Game
- Once transparency is the norm, phase out behind-the-scenes pricing deals between hospitals and insurers.
- This forces hospitals to set real, upfront costs for procedures.
Step 4: Shift Insurance Toward Covering Major Medical Events Only
- Most people don’t need insurance for routine doctor visits or minor procedures—just like you don’t use car insurance for oil changes.
- Small healthcare costs should be paid out-of-pocket, while insurance exists for surgeries, hospital stays, and emergencies.
This reduces unnecessary claims, keeps costs down, and stops hospitals from being flooded with minor cases that could be handled more efficiently outside the insurance system.
What About Medicaid?
One common counterargument: What about people who can’t afford out-of-pocket care?
That’s exactly why Medicaid exists—and it would still exist in this model.
- Medicaid would cover low-income individuals for both small and major medical needs.
- Instead of trying to expand government healthcare to everyone, we keep Medicaid for those who need it and allow the rest of the system to operate without as much government interference.
- This ensures no one falls through the cracks, while keeping the private system competitive and efficient.
What This Fixes Without More Government Control
We don’t need more regulation.
We don’t need more complexity.
We just need a system that isn’t built to extract as much money as possible from sick people.
The question is: Do we actually want a better system, or are we too comfortable with the one we’ve got?
Take back control of your health.
🔹 Stay tuned for Part 2, where we tackle another broken piece of the system—prescription drugs and medication pricing.
