Commentary: Time for a New Approach to Healthcare Reform

In a study released in the fall of 2020, State Auditor Doug Hoffer reported that Vermont’s healthcare costs had increased by 167% between 2000 and 2018. Keep in mind that those years saw a number of “reforms” that promised to reduce costs while increasing access and quality, including Catamount Health, Green Mountain Care (the failed attempt at single payer), and the latest debacle that is OneCare Vermont. All of these programs shared some common characteristics: they were all top-down, government centered, and bureaucratic.

It’s time to try a new approach, lowering costs by increasing transparency, restoring direct doctor/patient accountability, and eliminating expensive regulations and unnecessary middlemen.

There is a plan for such a framework coming together under the banner of “Healthcare For You,” personalized healthcare delivery, developed by the Job Creators Network. The group describes its efforts as the result of extensive market research, drawing on the input of more than 25,000 patients, doctors, and health care professionals, and “health reform that Americans want, not a backroom plan that politicians tell them they want.”

Key features of the Healthcare For You include transparent prices (doctors and hospitals would be required to publish a “menu” of prices for services), choice (giving patients the resources and flexibility to shop for the insurance and medical products that fit their needs), and restoring direct doctor/patient relationships by eliminating middlemen, third party payers, and bureaucratic red tape wherever possible.

The plan would allow individuals to use tax free dollars to purchase health insurance, which would be connected to the patient, not the employer, meaning no one would lose their coverage because they lost or changed jobs. It would allow states to reform insurance markets to allow individuals to choose what kind of policy they want, anything from a catastrophic plan to a Cadillac plan. Patients with pre-existing conditions would be protected through Guaranteed Coverage Pools.

Expanded access to Personal Health Management Accounts would allow employers to contribute tax-free dollars directly to employees for healthcare related purchases. This, in turn, would empower individuals to pay for medical care directly – options like membership-based primary care cooperatives, surgical centers, labs and imaging centers, etc. -- without going through insurance companies. This will lower costs two ways, by incentivizing providers to to provide higher quality and lower cost services to attract customers, and by eliminating the costs and inefficiencies of going through middlemen. Such transparent, direct payment systems have demonstrated that they can produce healthcare prices nearly 40% lower than insurers’ negotiated rates.

Finally, it is time to implement tort reform for medical malpractice cases. Even when Vermont was contemplating a single payer system, the architect of the plan, Dr. William Hsiao, called for moving to a no-fault legal framework such as those used in Scandinavia and New Zealand in order to reduce costs related to malpractice insurance and to curb “defensive medicine” (the expensive practice of conducting unnecessary tests and procedures to protect against potential legal liability rather than the best care of the patient).

Rising healthcare costs are crippling so many aspects of our economy. Businesses can’t afford it. Public sector benefits are consuming disproportionate amounts of public resources to pay for it. Families are being bankrupt because of it. This should be motivation enough to abandon the failed policies of the past and embrace a different approach to reform. However, this logic doesn’t seem to resonate with our political class at this point. Perhaps the Supreme Court taking up California v. Texas this month, the case that could potentially declare the Affordable Care Act (aka Obamacare) unconstitutional, will force their hand with a decision requiring new solutions.

You can learn more about Healthcare For You, and Personalized Healthcare, at


- Rob Roper is president of the Ethan Allen Institute.


Please check your e-mail for a link to activate your account.

Enter Comment Here: