Transparency, enforcement, and consequences—the solutions that work everywhere else
Real accountability measures exist. They work in other countries and in specific U.S. markets. The only barrier? They threaten industries that operate without accountability—and those industries fund both parties.
These aren't theoretical proposals—they're proven reforms that force transparency, enable negotiation, and create consequences for overcharging. They work everywhere they're implemented.
What it means: Hospitals and providers must give binding price quotes before any non-emergency procedure. If they can't tell you the cost upfront, they can't bill you afterward. Make them accountable to patients.
Why it works: Transparency creates accountability. When patients can see and compare prices, providers can't hide behind opacity. Price transparency laws in other countries have driven dramatic cost reductions.
The impact: Could reduce healthcare spending by 15-20% by forcing accountability and enabling actual competition.
Potential savings from forcing hospitals to disclose real prices
Hidden price variation that transparency would expose
What it means: Cut out insurance middlemen for routine care. Patients pay doctors directly through affordable monthly subscriptions ($50-100/month) that cover all primary care visits, basic procedures, and 24/7 doctor access.
Why it works: Eliminates billing paperwork, insurance denials, and administrative waste. Doctors spend more time with patients and less time fighting with insurance companies.
Average monthly subscription for unlimited primary care visits
Reduction in administrative costs at DPC practices
The impact: DPC practices are growing rapidly because they work. Combine this model with catastrophic insurance for major medical events, and you have affordable, accessible healthcare.
Direct Primary Care
What it means: Let Medicare negotiate drug prices transparently—the way the VA does and every other developed nation does. Force pharmaceutical companies to justify why Americans pay 10x what Canadians pay. Create accountability through public negotiation.
Why it works: The VA pays 40-50% less because it negotiates transparently. Other countries publish their negotiations and the justifications for prices. Accountability works.
What it means: Single billing standard across all payers. Automatic claim approval for standard procedures. Electronic health records that actually talk to each other.
Why it works: We waste $1 trillion annually on administrative complexity. Other countries manage with a fraction of this bureaucracy.
of healthcare spending goes to administration—not patient care
Annual waste from administrative complexity
The impact: Could save $500 billion annually by cutting administrative costs in half—which would still leave us with more admin spending than other countries.
These solutions are proven wherever transparency and accountability are enforced. The only reason we don't implement them nationwide is that accountability threatens the industries funding both parties' campaigns.
What it means: Enforce antitrust laws. Block anticompetitive hospital mergers. Break up existing monopolies. Force competition that creates accountability.
Why it works: Hospital consolidation eliminated accountability in 90% of metro areas. When hospitals compete, they must justify their prices or lose patients. Monopolies face zero accountability—and prices reflect it.
These five accountability measures could reduce U.S. healthcare spending by 30-40% while improving outcomes and access. They would:
Until voters demand representatives who will force accountability on hospitals, pharma, and insurers, nothing will change.
Real change requires voters to demand elected officials who will make the healthcare industry operate transparently—regardless of campaign donations. Hold politicians accountable for protecting the unaccountable.