by Deane Waldman
Democrats’ latest ploy to divert Americans’ attention from unaffordable insurance and inaccessible care is to add long-term care benefits to Medicare. They ignore the fact that adding new spending will hasten Medicare’s projected insolvency. Republicans’ latest solution emphasizes new rules about how you buy your health care, building on their sop of last December’s $1,500 for people to spend in lieu of ACA subsidies.
Both parties see regulation as the answer, the only answer, to our healthcare woes. Their proposals reaffirm the adage when all you have is a hammer, everything looks like a nail.
There is a seesaw with healthcare — one word, the system — on one side and health...care — two words, the service or patient-doctor connection — on the other. As Washington increases its regulation of healthcare, it gains power and money. Its side goes up. The other side, with patients on it, goes down.
The feds promise new benefits or financial support or expanded coverage. They take the money needed to deliver on the promise of care and use it to support the BURRDEN — bureaucracy, unnecessary rules and regulations, directives, enforcement, and noncompliance activities – that follows every legislative act.
BURRDEN costs money, lots and lots of taxpayers’ healthcare dollars. In 2025, BURRDEN consumed at least half of the $5 trillion the U.S. spent on healthcare. For perspective, Washington wasted an amount equal to the entire GDP of Canada – $2.5 trillion – on healthcare that produced no health care!
The Affordable Care Act (ACA) cost $1.76 trillion. Most of the money was spent creating new BURRDEN. This author can attest as he was a founding Director of the New Mexico Health Insurance Exchange, one of 50 such new bureaucracies created by the ACA. To defray ACA administrative expenditures, President Obama withdrew $716 billions from the Medicare Trust. That money was taken from care for seniors to pay for non-care, for BURRDEN.
HealthcareUP; health...caredown.
From 1965 to present, Congress passed thousands of different legislative acts that impact patients. Some have well-known names like Medicare, Medicaid, EMTALA (Emergency Medical Transport and Labor Act), HIPAA (Health Insurance Portability and Accountability Act) and the Affordable Care Act (ACA). Others had healthcare provisions buried in legislation that did not have health-related names such as the Inflation Reduction Act of 2022 and almost every annual OBRA (Omnibus Budget Reconciliation Act) since 1974.
All this legislation created a complex, redundant, and incredibly expensive regulatory structure whose sole purpose is to expand federal control. Between 1970 and 2020, the number of doctors doubled – it increased 100 percent. Over the same fifty years, the number of healthcare bureaucrats increased by more than 4,400%! The net effect was a massive increase in healthcare spending on newly created jobs for people who provide no patient care.
The financial effects of the healthcare seesaw are clear. As Congress passes new legislation, more money is diverted from clinical care to BURRDEN. Medicaid and Medicare reimbursement schedules keep going down. Medicaid rates are so low that physicians and dentists simply refuse to take new Medicaid patients.
Washington is spending trillions of dollars paying itself with money it doesn’t have. That spending is added to the national debt. In 2025, federal spending was $7.01 trillion. Revenue was $5.23 trillion yielding a deficit of $1.78. The amount wasted on BURRDEN was $2.5 trillion. If we reduced wasteful spending on healthcare by “only” $1.78 trillion, the U.S. budget would balance.
The health impacts of the seesaw effect have been devastating. In 1960, a patient waited hours to get a doctor appointment. In 2022, average maximum wait time was 132 days to see a general practitioner. The longer patients wait for care, the worse outcomes they experience. In fact, some Americans wait so long for care, they die while waiting in line. The seesaw’s death by queue has been documented in both Medicaid and Tricare.
Not only do we have a worsening shortage of physicians, more than one third of those still practicing refuse to see new Medicaid patients. This exacerbates the medically dangerous wait times.
As every child in the playground knows, a seesaw can go both up and down. If government spending on BURRDEN were reduced and the government side of the seesaw went down, the patient side would go up.
With fewer regulators and less bureaucratic spending, more dollars would be available to pay for patient care. With fewer regulations, time-wasting bureaucratic hassle would go down, encouraging doctors to stay in practice. More doctors would accept new Medicaid patients. Wait times would go down. More patients would get the care they need when they need it.
For the past sixty years, the government side of the healthcare seesaw has been moving upward. It is time to push it down and elevate We the Patients. The way to do this is by empowering patients: give Americans control of their healthcare spending instead of a third party regulated by Washington.
After all, it IS Americans’ money...and their lives.
Deane Waldman, M.D., MBA, is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former Director of the New Mexico Health Insurance Exchange; and co-author of award-winning “Become an Empowered Patient.” Follow him on X.com@DrDeaneW or visit website www.empowerpatients.info.
