How states can fix what Washington broke

When I look at U.S. healthcare, I see a system that was supposed to serve patients and doctors — not Washington, D.C. I see premiums that go up every single year while the care people actually receive does not get better. And I see an entire industry of benefits professionals caught in the middle, trying to make it work for their clients while the federal government keeps making it harder.

I think the reason is simple. The people who are supposed to be in charge of healthcare decisions (doctors and patients) have been cut out of the loop entirely. The federal government has for decades inserted itself deeply into every corner of American healthcare that we have built — the most expensive middleman operation in human history. And your clients are the ones writing the checks.

I spend a lot of time talking to Americans about what has gone wrong with the federal system. I run the nation's largest Article V grassroots organization whose mission is returning power from Washington to the states and citizens. That mission has everything to do with the cost crisis that is eating your clients alive. Because the problem isn't that healthcare is expensive; it's that we've made it expensive by letting Washington run it.

The standard D.C. playbook goes something like this: identify a healthcare problem, create a new federal program or regulation to address it, watch costs climb, then create another program to address the costs created by the first one. Repeat for 50 years. 

The Affordable Care Act alone added thousands of pages of regulations and spawned an entire compliance industry. And all those layers of bureaucracy don't come free. Somebody pays for them. That somebody is your clients' employees who watch their paychecks shrink every year while deductibles go up and choices go down. Premiums have roughly doubled in the past 15 years. Ask any working family whether their care got twice as good. You already know the answer.

Let me put it differently. If you were designing a healthcare system from scratch, you would never build it this way. You would never say, "Let's have people in Washington who have never met this patient, never visited this community and have no idea what healthcare costs in Boise versus Brooklyn dictate the rules for every employer plan in America." 

No rational person would design that. But that is what we have. And it is why the most important conversation in healthcare right now is not happening in Congress. It is happening in state capitals.

The concept is straightforward. Instead of routing healthcare dollars through the federal bureaucracy, where a staggering amount gets absorbed by administrative overhead before it ever reaches a patient, block-grant those tax dollars back to the states. Let governors and state legislators who actually understand local labor markets and healthcare landscapes design systems that work for their populations. Let states compete with each other for better outcomes and lower costs, the same way businesses compete for customers.

When you remove the one-size-fits-all mandate from Washington, states innovate. Some prioritize direct primary care. Some expand health savings accounts. Some negotiate directly with providers on pricing. The point is not that there is one right answer; it's that 50 states trying 50 different approaches will find better answers faster than one Congress trying to manage healthcare for hundreds of millions of people.

For benefits advisers, this shift matters in concrete ways. A state-led healthcare framework means more plan design flexibility for your employer clients. It means the possibility of real price competition among providers and insurers within state markets, which is the single most effective force for lowering costs. It means fewer layers of federal compliance that add cost without adding value. And it means your role becomes more strategic, not less, because employers navigating a state-driven landscape will need advisers who understand the new terrain.

There is growing momentum behind what many are calling "medical freedom:" the idea that healthcare decisions should be made by patients and their doctors, not by federal agencies. This is not a fringe position. It reflects a frustration that crosses political lines. And it is already producing real legislative action at the state level because people are tired of waiting for Washington to fix what Washington broke.

The federal healthcare apparatus took decades to build. It will not be dismantled overnight, and nobody serious is proposing that. But the path forward is clear: push decision-making and dollars closer to the communities where healthcare actually happens. Restore the relationship between doctors and patients, and give benefits professionals the room to do what they do best: design plans that actually serve the people enrolled in them.

The system is not going to reform itself from the top down. It never does. Real change starts closer to home.