Spend Right – Not More – On Healthcare

The Veterans Administration is once again in crisis. A just-released Inspector General report found “severe occupational staffing shortages” across critical specialties, including primary care, anesthesiology, and mental health. Nearly 80 percent of VA facilities reported not having enough staff to meet veterans’ care needs. For many who served our nation, this means longer wait times, delayed treatment, or no care at all, especially mental health.

We’ve seen this before. In 2014, when veterans were dying waiting in line for care, Congress rushed through a $10 billion bailout. Yet here we are again, a decade later, with billions more spent and the same tragic outcomes. Veterans deserve better than broken promises and bureaucratic excuses.

The VA is a symptom of a more profound truth: America doesn’t suffer from underfunded healthcare, but from mismanaged spending.

First, we spend more than enough—just in the wrong places.

In 2024, the United States spent $4.9 trillion on healthcare, more than Germany’s entire economy. The average family paid $32,065 in costs. Yet more than half of those dollars never reached patients. They were absorbed by what we call BURRDEN: Bureaucracy, Unnecessary Rules and Regulations, Directives, Enforcement, and Noncompliance activities.

This “BURRDEN” is exploding. In 1999, administrative costs were about 31 percent of healthcare spending. Today, they exceed 50 percent. Between 1970 and 2020, the physician workforce doubled, but the number of administrators skyrocketed by 4,400 percent, resulting in 44 new overseers for every one new doctor. Patients don’t need more compliance officers—they need doctors and nurses.

Second, the incentives put patients last.
Third-party payers—government programs and private insurance companies—control the majority of healthcare dollars, and their incentives are often misaligned. Insurers maximize profits by delaying, deferring, or denying care—a “3-D strategy” that leaves patients in limbo. Federal agencies maximize their budgets and staff. Politicians expand programs and create non-clinical jobs to garner votes. For both, patients are an afterthought.

The Affordable Care Act illustrates this misalignment. It cost $1.76 trillion, funded partly by $716 billion siphoned from Medicare. What did patients get? Average wait times of 132 days for a primary care visit—four and a half months just to find out if abdominal pain is gas, an ulcer, or cancer.

The VA shows the same problem. Despite some of the highest per-patient spending in the world, veterans face “death by queue,” a fate long associated with the U.K.’s single payer  National Health Service.

Third, the cure is to empower patients, not bureaucrats.

The purpose of healthcare is care, not sustaining much less expanding bureaucracy. That means restoring financial control to patients. When individuals—not Washington—decide how to spend their healthcare dollars, incentives align: care instead of bureaucracy is rewarded. Providers compete to deliver timely, high-quality, affordable care. Prices and spending go down.

Our proposed Empower Patients Initiative, published by Americans for Tax Reform, offers a framework that includes a $24,000 pay increase, no-limit health savings accounts, complete price transparency, and converting federal programs into state block grants to encourage innovation and cut costs.

This is not abstract theory. In Illinois, hundreds of Medicaid patients have died waiting for care. In Texas, fewer than half of doctors accept new Medicaid patients. In the VA, the latest IG report confirms veterans are still left without timely treatment despite decades of funding increases.

America spends more than any other nation on healthcare, yet patients are dying waiting in line while bureaucracies continue to thrive. As long as third parties remain in control, money will flow to administrators, not patient care.

Real reform begins with trust. Trust patients to make choices. Trust doctors to provide care without layers of permission slips. Trust states to innovate. Spending more won’t heal American healthcare. Empowering patients will.

About the authors

Deane Waldman, MD, MBA, is professor emeritus of pediatrics, pathology, and decision science; former director of the Center for Healthcare Policy at the Texas Public Policy Foundation; and former director of the New Mexico Health Insurance Exchange. Follow him on X @DrDeaneW or visit deanewaldman.com.

Vance Ginn, PhD, is president of Ginn Economic Consulting, host of the Let People Prosper Show, and previously served as chief economist of the White House’s Office of Management and Budget during the Trump administration. Follow him on X @VanceGinn or visit vanceginn.com.

They are co-authors of the new book, Empower PATIENTS – Two Doctors’ Cure for Healthcare

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.