Empower Patients, Reclaim Healthcare
Gallup recently reported that healthcare remains the biggest domestic concern for Americans. It is clearly their longest-running frustration (60+ years). Yet, Washington won’t even consider an effective solution called the Empower PATIENTS Initiative (EPI).
President Trump may have been merely musing when he gave the answer: “Give the money to the people instead of insurance companies.” In August 2025, Americans for Tax Reform sent a detailed proposal — EPI — to Congress with financial models, numerous projections, as well as a wealth of evidence (184 references) showing a way for healthcare to provide timely, affordable medical care to Americans. Three added bonuses of the EPI plan are saving $2 trillion of federal spending a year, the elimination of medical fraud, and the restoration of medical autonomy.
Of course, people will be anxious about EPI. Without a doubt, the biggest issue will be the fear of change.
No one in Washington is giving EPI serious consideration. Why?
Because the way to make healthcare work for We the People requires spending control by We the People. That takes power and money away from third parties — heresy to Washington politicians, bureaucrats, insurance executives, and their lobbyists.
Small segments of the healthcare community are already trying this no-insurance, patient-pays approach, such as direct primary care, free market surgery centers, and even pharmacies. And it works: consumer costs are much lower, service is prompt and personal, and providers still make money.
EPI starts with paying 84 million American workers their full wages, adding approximately $26,993 to each paycheck. That is the average amount employers took from employee earnings last year as so-called “employer-sponsored” health insurance benefit (ESI).
ESI was an accommodation made in 1942 to wartime wage freezes. All the wage freeze legislation was repealed after the war, except the ESI. For more than 80 years, employees have been denied all the money they earned based on an obsolete, market-destroying law masquerading as employer generosity while functioning like a money tree for insurance companies.
Repealing the ESI is not only the right and fair thing to do; it will begin the healing process for healthcare. When patients are empowered, i.e., when they control their healthcare spending, prices will plummet, and service will become prompt. This happens because free market forces are once again in effect.”
Empowered patients are no longer subject to insurance carriers’ pre-authorization process, which is extremely unpopular with Americans. Empowered patients can make their own medical decisions. Medical autonomy or freedom — long denied by a third-party payment system — is restored.
Let people put those funds in a tax-free (new) no-limit HSA and shop for both care and insurance. Add unrestricted Medicaid block grants to the states and pay out Medicare into (new) senior no-limit HSAs before the program goes broke.
Repeal federal insurance limitations like Biden’s ban on short-term insurance. Insurers can then offer plans that people want rather than unaffordable, inadequate policies mandated by Washington. Most people will happily buy high-deductible, catastrophic insurance policies from their well-funded HSAs. Insurance would return to its true function — managing financial risk — and cease supplanting physician judgment.
Virtually all medical fraud occurs through the third-party billing and collecting process. That is how all Medicare scams work. That is how the Somali community embezzled as much as $9 billion from Minnesota Medicaid. With EPI, patients, not third parties, pay providers. If patients don’t get the services they are paying for, like child care or treatment for autism, it will be obvious.
EPI will dramatically reduce the need to spend on BURRDEN — bureaucracy, unnecessary rules and regulations, directives, enforcement, and noncompliance activities. In 2025, this spending that produced no patient care cost taxpayers more than $2 trillion.
Of course, people will be anxious about EPI. Without a doubt, the biggest issue will be the fear of change. Many widely accepted but erroneous healthcare myths must be challenged, like health care is a right or that having insurance assures timely care. When presented with facts instead of narratives, Americans will see why they must demand EPI to reclaim their medical freedom.
Despite all the advantages of the Empower PATIENTS Initiative, it has never been openly discussed in Congress for the obvious reason: loss of power and money. Healthcare will never be fixed from the top down. Only bottom-up will work. It will require a groundswell of millions of Americans saying at the ballot box, “Promise to support EPI or you don’t get my vote.”
READ MORE from Deane Waldman:
Empowering Patients in a Broken System
How Medicaid Made a Billion-Dollar Crime Inevitable
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. He co-authored “Become an Empowered Patient” with Dr. Vance Ginn. Follow him on X @DrDeaneW and visit www.empowerpatients.info or www.deanewaldmanbooks.com.