Welcome to this episode of the Let People Prosper Show, where we discuss critical issues in public policy, economics, and the future of prosperity. Today’s guest is Joe Grogan, founder of Fire Arrow Consulting and a leading healthcare policy expert with decades of private and government experience. Joe served as the Director of the Domestic Policy Council under President Trump, where he played a pivotal role in shaping healthcare policy, including efforts to improve transparency and market competition. He is also the co-host of the DC EKG podcast, where I was recently on his show to dive into healthcare reform, economic policy, and the power of state-level innovation.

For more insights, visit vanceginn.com and get even greater value with a subscription to my Substack newsletter at vanceginn.substack.com. 

(0:00) – Introduction to Healthcare Policy and Joe Grogan’s Background
Joe shares how his experience in both the private and public sectors shaped his views on healthcare reform.
(3:09) – The Evolution of U.S. Healthcare Policy
Exploring how the Affordable Care Act and past reforms have altered the healthcare landscape.
(6:01) – Challenges in Reforming Healthcare
Joe delves into the bureaucratic barriers and inefficiencies that complicate meaningful reform.
(14:57) – Price Transparency and the Marketplace of Healthcare
Discussing the critical need for transparency and how it can transform healthcare into a functioning marketplace.
(28:40) – Federal Block Grants for State Flexibility
Examining how block grants could simplify and improve Medicaid while empowering states to innovate.
(34:55) – Data Transparency and Government Accountability
How improving data availability can drive innovation and ensure better healthcare outcomes.
(42:52) – Future Opportunities in Healthcare Reform
Joe shares his optimism for bipartisan solutions and what needs to happen next to empower patients and improve efficiency.
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Originally published with Deane Waldman, M.D., MBA at The Center Square.

President Donald Trump faces many problems left by the outgoing Biden administration. One of them is the world’s most expensive health-care system, as millions of Americans struggle to access timely, quality care. In 2024, the nation spent an astonishing $4.9 trillion on health care – more than the entire GDP of Japan.

Much of this money never reached doctors or hospitals. Instead, it was consumed by bureaucracy, unnecessary regulations, and compliance activities. We must fundamentally rethink how to allocate resources to save money and improve care.

The solution isn’t more funding; it’s defunding the bloated system and empowering patients, something that Trump should consider to empower patients with better, affordable care.

The problem lies in inefficiency. The U.S. spends far more on health care per capita than other developed nations. In 2023, Americans spent an average of $12,742 per person on health care. Compare that to Israel ($3,469), the United Kingdom ($5,867), or even Switzerland ($9,044).

The difference isn’t due to better outcomes or superior care – it’s because American health-care dollars are being diverted into an inefficient system.

A large portion of U.S. health-care spending goes to what can be described as BURRDEN: bureaucracy, unnecessary rules and regulations, directives, enforcement, and noncompliance activities. Research suggests that these non-clinical activities consume 31% to 50% of U.S. health-care spending. That means between $1.52 trillion and $2.45 trillion annually could be saved or redirected toward actual care.

Envision a scenario where patients – not bureaucracies – control these resources. If employees receive the $23,968 as part of the compensation their employers currently spend on health insurance, they can make their health-care decisions. These funds are currently directed toward insurance companies but could be returned to workers, empowering them to shop for care directly.

Giving consumers control over their health-care dollars could restore market forces to the system, driving down prices and improving service quality.

The evidence supporting patient empowerment is compelling. When patients pay directly for care, providers must compete for their business by offering better prices and higher-quality services. This dynamic can already be seen in direct-pay surgery centers and cash-only primary care practices.

At the Surgery Center of Oklahoma, for instance, patients can see the total cost of procedures upfront. This is generally a fraction of what traditional, insurance-based hospitals charge. Transparency and competition create savings while simultaneously improving quality.

Critics argue that patients lack the knowledge to make complex medical decisions. However, the same could be said for hiring a lawyer or choosing a car mechanic, yet consumers navigate these markets daily. Empowering patients doesn’t mean abandoning them; it means providing tools like transparent pricing and quality data to help them make informed choices.

For example, health savings accounts (HSAs) could be expanded and more flexible. This would allow families to save tax-free for medical expenses and spend those funds as they see fit, including on insurance policies they want, instead of being limited to what Washington allows.

Defunding the health-care system doesn’t mean cutting care. It means cutting the inefficiencies that inflate costs and hinder access. We could achieve substantial savings by streamlining regulations and reducing administrative waste while improving the patient experience. Elon Musk’s Department of Government Efficiency, or DOGE, can make history by tackling health-care reform as its priority. Starting with health-care offers wins for finances and people.
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Without reform, health-care spending will continue to rise, draining public funds and household budgets. Meanwhile, millions of Americans will remain stuck in a system prioritizing paperwork over patients. By defunding the bloated bureaucracy and empowering individuals, we can create a system that delivers better outcomes at a fraction of the cost.

It’s time to give Americans what they deserve: affordable, accessible health care that puts their needs first.

By Deane Waldman & Vance Ginn

Originally published by Real Clear Policy with Dr. Deane Waldman.

In 1960, President Kennedy promised the U.S. would put a man on the moon within a decade. The experts scoffed, saying it was impossible based on the science, or the lack of it. Nine years later, Neil Armstrong stepped on lunar soil.

Today, talking heads as well as the public believe that fixing healthcare is impossible – it can’t be done! Doctors Ginn and Waldman disagree. They ascribe to the optimists’ credo: the difficult we do today; the impossible takes a little longer.

The burning platform theory says that people will refuse to get off a shaky, unstable, dangerous platform but will quickly vacate if it is on fire. Healthcare is on fire. People are likely to accept big changes today that they would have resisted years ago. Healthcare has reached its tipping point. The formation of DOGE is proof that fundamental change is possible.  

Our New Year resolution for 2025 is to cure our impossible-to-fix healthcare system. The cure should produce a system that will allow Americans to obtain the care they want when they need it while simultaneously breaking the national addiction to overspending. The cure will require many, substantive changes over time. The impossible takes a little longer.

The first step is to pay American workers all the money they earn. The so-called benefit of employer-supported health care is an obsolete, market-distorting holdover from wage freezes enacted during World War II that deny workers all they are owed. On average, employers are currently giving $23,968 of employees’ earnings to insurance companies instead of paying that money to employees. Step #1 in the cure is paying the $23,968 to employees, not to insurance.

The natural place to park these funds would be some type of bank account for medical expenses. That is a problem. There are at least three different forms of such accounts: Health Savings Account (HSA), Flexible Spending Account (FSA), and Medical Savings Account (MSA). Each has multiple different governing regulations – federal, state, and various insurance plans. Some have use-it-or-lose-it time limits. Several insurance plans do not accept such accounts.

HSAs have contribution limits such as maximums of $4150 for an individual and $8300 for a family. Thus, at least $15,668 of earnings cannot be contributed at present. Furthermore, federal regulations stipulate what are allowable medical expenses and what are not – a choice that should be made by the patient not the government.

Restrictions on HSAs are a form of government control where regulations are unnecessary, inappropriate, and costly. Americans should be free to spend their hard-earned dollars as they see fit. Medical outlays should be tax-free for employees as they are now for employers.

Next, it is necessary to unleash the power of an HSA but in a new, simplified and unlimited form, starting with its name.

The purpose of healthcare is Care. The function of healthcare dollars is to Spend on care, not saving them. Thus, the new medical account should be called a Care Spending (not Savings) Account or CSA. There is no need for other accounts like the current HSA, MSA, or FSA. 

There should be no limit on how much a family can contribute to an CSA and no time limit to use these funds. The account should be passed across years and generations. CSA monies can be spent on any health-related expenditure. In addition to standard care, medications not approved by the FDA (like ivermectin for COVID), crystal therapy, aromatherapy, and other forms of alternative medicine should be allowed while a big screen TV or a new automobile should not. If a family wishes to spend their CSA money on medical expenses for a non-family member, that too should be allowed.

In other words, Americans should be free to engage in tax-free spending on their medical care with no government direction, regulation, or coercion. Just because the Biden Administration labeled short-term insurance as “junk,” doesn’t mean Americans should be prohibited from purchasing it.

The CSA would require no regulatory apparatus other than IRS oversight. It will eliminate the need for and spending on the BURRDEN – Bureaucracy, Unnecessary Rules and Regulations, Directives, Enforcement, and Noncompliance activities – of HSA, MSA, and FSA. This will save billions of taxpayer dollars and improve access to reliable, timely care.

With more than $20,000 per year in an CSA to spend directly on care, and no third-party insurance costs or expenses for BURRDEN, providers can offer consumers drastically reduced prices for cash-only services and goods. Suddenly, that $2500 MRI would cost $750, easily affordable from the CSA. Even the $15,499 price tag for hip replacement at cash-only Oklahoma Surgery Center is not a problem. And for the rare, six-figure heart attack or cancer chemotherapy, there is high deductible catastrophic insurance (when and if Washington will stop over-regulating insurance.)

The CSA shows the impossible is possible: it saves consumers’ money and simultaneously pays more to providers. A standard charge through insurance for hip replacement is $35,114; Medicaid pays $12,922. As noted previously, the cash-only, no insurance charge to the patient is $15,499, not $35,114. Payment from the CSA to the provider is $15,499, not $12,922. And, the provider is paid immediately, not after two years of aggravating insurance reviews. 

While many more actions are necessary to make health care accessible and affordable, the first two steps are as outlined. (1) Pay workers ALL the money they earn and let them spend it as they choose. (2) Provide a tax-free spending haven for medical expenses with a no limit (time or money) CSA.

The next part (step #3) of the New Year resolution involves turning Medicaid into a functional and sustainable medical safety net, which it most certainly is not.

​Originally published by American Spectator with Dr. Deane Waldman.

The murder of Brian Thompson, CEO of UnitedHealthcare, was a heinous crime allegedly done by Luigi Mangione out of rage against the machine. Presumably, his target was someone who profits from our broken healthcare “machine” or system.

President Obama was overt in Washington’s theft of taxpayer dollars intended to pay for care.

Public frustration with, anger, and even “hatred” toward healthcare may seem justified based on facts, but violence is never the answer. Healthcare seems to turn hard-earned taxpayer dollars into massive health industry profits and wasteful bureaucratic spending. And what does the public get? Questionable insurance policies with promises of care that never materialize, drugs that don’t work, and physicians who spend most of an appointment looking at a computer screen rather than talking with patients.

Last year, the U.S. spent $4.8 trillion on its healthcare system, 17.5 percent of our GDP and more than the entire GDP of Japan. American families spent $31,065, on average, on healthcare costs in 2023, of which 83 percent went to insurance companies. (READ MORE: Federal Bureaucracy Is Biggest Healthcare Rent-Seeker)

Insurance is one of the most profitable industries in the country, so Mr. Thompson may have seemed a symbol of the evils of capitalism against which Mr. Mangione railed in court. Insurance companies typically generate profits by not paying for medical care. They use a 3-D strategy — delay, defer, deny — which was dramatized in the 1997 movie, “Rainmaker,” where a greedy insurance executive denied a claim for payment for the treatment of a cancer patient, claiming the therapy was experimental and therefore not covered. The young man died despite having a potentially treatable condition.

People holding a health insurance policy have been led to believe they will receive timely care. Yet the healthcare machine assigns them a provider. A pharmacy benefits manager chooses their medications. With insurance, the maximum average wait time to see a primary care physician in a mid-sized city is 132 days. Some patients with either Medicaid or Tricare insurance wait so long for care, they die while waiting.

Thus, while nothing exonerates the murder of another person, public outrage seems justified.

Federal Bureaucracy Impedes Care
Moreover, private insurance is not the biggest culprit in taking our money and denying us care. That trophy goes to Washington.

Just recently, Elon Musk, co-leader with Vivek Ramaswamy of the non-governmental DOGE (Department of Government Efficiency), expressed shock at the “skyrocketing administrative costs” of the federal healthcare bureaucracy. He refers to healthcare spending that provides no care.

The word bureaucracy is too insignificant to express all the costly activities between Washington passing a healthcare law and the impact on Americans. The process invariably generates BARRCOME -- bureaucracy, administration, rules, regulations, compliance, oversight, mandates, and enforcement. One look at the organizational chart of the Affordable Care Act (ACA) proves how convoluted, complex, confusing, and costly is Washington-controlled healthcare.

Estimates of the cost of BARRCOME range from 31 percent to more than 50 percent of U.S. healthcare spending. Between 1970 and 2010, when the number of physicians doubled, healthcare bureaucrats increased by more than 3,000 percent! No wonder a businessman like Musk would be appalled at an industry where half the money expended produces no value for consumers.

In 2023, Americans paid $4.8 trillion for “healthcare.” Washington took possibly $2.4 trillion of it and paid for BARRCOME workers, not care providers.

President Obama was overt in Washington’s theft of taxpayer dollars intended to pay for care. To defray the cost of ACA BARRCOME, former President Obama and Congress redistributed nearly $800 billion from expected spending on Medicare even as revenue increased, thereby extending the date of insolvency for the program.

There is good reason for Americans’ rage against the healthcare machine. But violence, including murder, cannot be justified. While insurance can be a target for change, the bigger, more appropriate offender is federal spending and the resulting bloated bureaucracy. (READ MORE: Harris’ Healthcare Destroys Health CARE)

Hopefully, the DOGE will use deregulation, spending cuts, and government employment termination rather than life termination to improve patient care at a lower cost. Musk and Ramaswamy have set a goal of cutting $2 trillion from the federal budget. Reducing healthcare BARRCOME would accomplish that task while providing more dollar-efficient, more accessible, and affordable health care.

Originally published at Wall Street Journal. 

​Messrs. Musk and Ramaswamy’s proposal for the Department of Government Efficiency, or DOGE, presents a promising opportunity to restore constitutional governance. A clear path for reform exists within Medicaid: Enforce Section 1801 of the Social Security Amendments of 1965 that created Medicaid.

This law prohibits federal control over both medical care and how a state operates its Medicaid program. Yet decades of overreach have transformed Medicaid from a limited safety net to an unwieldy program covering 92 million Americans, encouraged by the flawed formula that rewards overspending.

By rescinding federal regulations and limiting federal involvement to block grants, DOGE can return control to states, saving taxpayers billions. Implementing Section 1801 requires no new law. An executive order enforcing existing statutes would suffice. This aligns with DOGE’s objectives of regulatory rescission, administrative reduction and cost savings while upholding constitutional principles.

​Deane Waldman and Vance Ginn
Round Rock, Texas.