Five Ways to Start Fixing America’s Health Care System

Key Takeaways

• Break up vertically integrated insurers like UnitedHealth to curb profit-driven cost hikes
• Classify insurer medical directors as practicing physicians, subject to malpractice liability
• Apply FTC HHI thresholds to health insurance markets to break monopolies
• Mandate evidence‑based, universal coverage policies independent of insurer profit motives
• Implement community‑rated universal insurance with subsidies funded by modest tax increases

Pulse Analysis

The United States spends more on health care than any other nation, yet prices keep climbing because insurers have morphed into massive conglomerates that own hospitals, physician groups, and pharmacy benefit managers. This vertical integration creates conflicts of interest, as illustrated by UnitedHealth paying its own doctors up to 17% more than independent peers, inflating overall costs. By separating insurance from care delivery, policymakers could restore market discipline, force insurers to compete on price rather than leverage ownership to boost margins, and ultimately lower out‑of‑pocket expenses for consumers.

Antitrust tools such as the Herfindahl‑Hirschman Index (HHI) provide a quantitative way to assess market concentration. In 2024, only three states and D.C. fell below the 2,500 HHI threshold, while eight states exceeded 7,000, a level that would trigger FTC action in any other industry. Applying the same rigor to health insurance could dismantle regional monopolies, spur new entrants, and give patients more plan choices. Greater competition is expected to drive innovation, improve service quality, and compress premium growth, echoing the benefits seen in sectors like telecommunications after similar interventions.

Achieving universal coverage in a country with a $32 trillion GDP is financially feasible if funded through modest policy tweaks. Community‑rated premiums, combined with targeted subsidies for low‑income workers and small businesses, could be financed by a small national sales tax or a slight increase in corporate and high‑income tax rates. Such a system would decouple health‑care access from employment status, reduce administrative waste, and align coverage decisions with clinical evidence rather than profit motives. While political hurdles remain, the proposed legislative package offers a realistic roadmap to a more equitable and sustainable health‑care landscape.