A routine doctor’s visit should not require the same payment system as a heart transplant. Yet that is how health insurance often works, managing predictable care that patients should be able to buy directly. The result is hidden prices, prior authorization, and higher insurance premiums. The problem is not that better models do not exist. It is that federal and state rules still make those models harder for doctors to offer through narrow HSA rules, Affordable Care Act benefit mandates, state insurance laws and Medicare opt-out requirements.
Many patients already buy routine care directly from providers while reserving insurance for major expenses. Direct primary care, health savings accounts (HSAs), catastrophic insurance, and cash-pay specialty clinics offer that alternative. They do not eliminate insurance. Instead, insurance is reserved for major events while patients pay their doctor directly for primary care. But these alternatives are still forced to operate around regulations designed for traditional insurance, not direct patient-provider payment, protecting insurance from competition.
Direct primary care shows how the system could be different. Patients pay a flat monthly fee, typically ranging from $600 to $1,200 per year, for core primary care services such as office visits, preventive care, and sometimes basic labs. For patients, that means a simpler experience with clearer costs, easier access, and a more direct relationship with their doctor.
Justin Leventhal is a Senior Policy Analyst for the American Consumer Institute, a nonprofit education and research organization that advocates for consumers through evidence-based analysis and data. Follow Justin on X @JustinLeventhal