The cost of health care has become one of the biggest problems facing our country. Almost 30% of the federal budget is spent on healthcare programs and services. Out-of-pocket expenses rise each year, while workers’ wages stagnate due to the higher premiums their employer must cover. Affordability concerns will remain front and center this year, especially as the temporary ACA subsidies expire and many enrollees face higher monthly premiums under the law’s existing structure.
Despite how much we pay for health care, it seems we often don’t have the best access to care. Doctor’s appointments have to be scheduled a month in advance on average, and up to 42 days for a specialist visit. Then, once you see that doctor, the appointment is just 15 minutes or less, which limits their ability to provide quality care. The U.S. has some of the worst health outcomes, such as shorter lifespans and high rates of preventable deaths, compared to other developed nations. These outcomes reflect deep structural problems in our healthcare system that more funding or government intervention could not solve.
Many reforms to simplify health care have been proposed and implemented, such as price transparency and removing CON laws, but the system is very complicated and opaque, which makes progress slow. And universal health care is not the answer. Even if the government could afford to pay for Medicare-for-all, it would require huge tax increases, reduced pay for hospitals and doctors, leading to lower-quality care. Furthermore, transitioning over 150 million people from their employer insurance would be extremely difficult and costly. While it seems like an easy fix on the surface, and is a great rallying cry, it is not truly feasible. That leaves us in a pretty bleak position.
Except it does not have to be. This is an opportunity for Americans to approach health care differently. There are options outside of the typical insurance system that serve as a better model and have been growing. Individuals can choose to participate in these right now, to take control of their healthcare expenses and get better care, rather than staying in a failing insurance market.
Health insurance is not equivalent to healthcare access or affordability. Insurance overcomplicates the system with middlemen, which drives up costs to the point where cash prices are significantly lower than insurance rates. For example, a knee replacement costs $26,115 on average nationally with insurance. In cash, the average cost is $13,734 at a surgery center and $18,096 at an outpatient hospital. These other models have found a way to offer their services at much more affordable cash prices, with absolutely no insurance involvement.
One such alternative is Direct Primary Care (DPC). This is a cash-only practice where patients pay a monthly membership fee to access a wide range of primary health care services and procedures. The monthly membership fee is typically $50 to $150 and includes unlimited same- or next-day appointments, 24/7 communication access with your doctor, and a wide range of services provided during appointments. Any additional services or procedures not included in the membership are offered at wholesale cash prices. Office visits are 30 to 60 minutes long, allowing for a greater doctor/patient relationship and emphasis on preventative care. According to the DPC Frontier Mapper, a tool that can search for DPC clinics by zip code, there are 2,840 DPC clinics around the country and at least one in every state. DPC clinics have an average of 402 patients, so it can be reasoned that there are about 1.14 million Americans who have a DPC membership.
DPC does not pay for or provide care for emergencies or serious illness. Even though they do not accept insurance and it is not required for membership, it is recommended to have a high-deductible insurance plan or health sharing plan for coverage in those instances. If you have an HSA with that emergency coverage plan, those funds can now be used to pay for a DPC membership due to the OBBBA.
Another cash-only model growing in popularity is surgery centers. For example, the Surgery Center of Oklahoma (SCO), founded in 1997, posts fixed, transparent prices on its website for a wide range of surgical procedures—including general, oral, orthopedics, podiatry, urology, and more. For example, a knee replacement costs $17,679. They post the all-inclusive price of every procedure directly on their website, which is often six to eight times cheaper than hospitals. With no excessive administration costs or incentives to get more reimbursement dollars, they were able to keep their prices the same for over 25 years and just recently raised them for the first time due to high inflation.
It is important to note that cash-only surgery centers and DPC can and do have contracts with employers to offer these services as part of employee health benefits. They offer much more affordable and predictable healthcare expenses. DPC in particular has the potential to support a healthier and happier workforce that is more productive, takes fewer sick days, and has fewer expensive medical needs due to the better preventative care they receive.
As the debate over America’s healthcare future continues, we don’t have to wait for sweeping federal reforms to get affordable and accessible health care. Models like Direct Primary Care and cash‑based surgery centers are already proving that transparent pricing, longer appointments, and patient‑centered care are possible outside of the insurance status quo. By embracing these alternatives, individuals and employers can claim control over their healthcare spending and experience better outcomes in the process. The system may be broken, but innovative solutions are growing all around us, and we are free to choose care that actually works.