Originally published on Substack. 

​America is drifting into one of the most important battles of the 21st century without acting like it: the fight for global biotech leadership. And the stakes aren’t academic—they’re personal for families like mine.

Prescription drugs save lives. I didn’t learn that from a textbook or a hearing room. I learned it as a kid watching my parents’ marriage struggle under the weight of a condition modern medicine couldn’t control—and later, as a passenger in a mangled car that should have ended my life.

Today, I want to explain why the future of healthcare, U.S. competitiveness, and patient freedom all hinge on one fundamental truth: innovation thrives when government steps back and people are empowered.

How Limited Medicines Helped Break Up My Family
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My parents married and divorced twice over five years in the 1980s. The first divorce happened in 1986, when I was five. Here’s a picture of us when I was about 14 years old, when my dad visited for the holidays.

A major reason for the divorce was my dad’s epilepsy, which my mom couldn’t deal with, given her own battles. He developed epilepsy over time after having a traumatic head injury from a car wreck as a passenger in 1972 when he was 18. The grand mal (and petit mal) seizures were violent, unpredictable, and impossible to manage fully. And in the mid-1980s, the epilepsy drugs available today didn’t exist. Treatments were limited, unreliable, and expensive. That instability seeped into everything—our finances, our home life, and eventually, my family structure.
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Even after my parents remarried a couple of years after their first divorce to help with finances, his condition and the overall situation kept weighing us down, and my parents divorced again. My dad fought severe seizures for decades until SUDEP took him too soon at 56 years old in 2011. That experience taught me early that the cost of poor medicine isn’t measured in dollars—it’s measured in broken families and lost years.

The Wreck That Should Have Been the End

Fast-forward to 2002 (30 years after my dad’s wreck), when I was 20 years old. I was riding shotgun in a friend’s new Acura RSX going 120 mph, racing another car, when we crashed into another vehicle, rolled at least 6 times, and skidded upside down for 40 yards. Here’s what the car looked like at the impound lot.

That moment is welded into memory. It’s why I can’t treat drug policy debates as political theater. Not when I’ve seen what access—or lack of access—means for real families.
​
Innovation Is Slow, Expensive, and Fragile

Now let’s talk economics, because too many in D.C. substitute talking points for actual understanding.

Discovering and bringing a single drug to market takes:

• 10–15 years,
• often $2.5+ billion, and
• a 90% failure rate.

That’s not waste. That’s the cost of life-saving innovation.

If Washington restricts returns, imposes price controls, or injects uncertainty into reimbursements, investment falls. And when investment falls, breakthroughs disappear. Families like mine wait for cures that never come.
That’s not ideology. That’s basic economics, the kind some populists seem allergic to learning. Research shows that a forced 50% cut in drug prices could reduce new drug development by 30%—a devastating blow to future patients.

China Is Not Catching Up—China Is Planning to Win

While Washington debates how aggressively it can regulate American innovators, China is executing a full-scale industrial strategy under its “Made in China 2030” biotech framework:

• Giant state-backed biomanufacturing hubs
• National research parks tied to Party goals
• Aggressive recruitment of American and European scientists
• AI-driven drug-discovery platforms fed by massive datasets
• Total-state effort to dominate global supply chains

China isn’t catching up. China is positioning itself to control the next century of medical innovation while we argue about political gimmicks like MFN drug pricing, “TrumpRX,” or tariffs that pretend to solve problems Washington created.

That is not how markets work.

That is not how science works.

That is not how you compete with China.

Lower Prices Require Abundance—not Bureaucracy

If we want lower drug prices, the answer is simple:

• Increase supply.
• Increase competition.
• Increase innovation.

Prices fall naturally when abundance rises—not when politicians cap prices and shrink the pipeline of new cures.

• Price caps don’t lower costs—they eliminate future treatments.
• Tariffs don’t strengthen supply chains—they drive production abroad.
• Central planning doesn’t accelerate cures—it suffocates them.

That brings us to the model that works.

Empower Patients: The Pathway to Win Against China

This is exactly why I helped develop the Empower Patients (get your copy today!) blueprint with Dr. Deane Waldman, and why its core reforms aren’t optional—they’re essential.

1. Put healthcare dollars in the hands of patients through no-limit HSAs

• Fund them with the tax exclusion currently given to employers.
• Patients own the dollars.
• Patients see real prices.
• Patients drive the market.

This is how you create competition and transparency—not by empowering insurers or bureaucracies.

2. Block-grant Medicaid to the states

• Washington can’t manage 50 different populations from one office.
• States innovate; Washington regulates.
• Only one of those approaches works.

3. Streamline the FDA

• Every year of regulatory delay raises costs, slows cures, and weakens our global position.
• Modernized trials, reciprocal approvals, and faster pathways save billions—and lives.

4. Build America’s biotech supply side

• Stable R&D rules.
• Predictable regulation.
• Competitive taxes.
• Less government spending and fewer distortions.

Make the U.S. the best place to research, develop, and manufacture cures—period.

Why This Matters

My family broke apart partly, if not mostly, because the medicines my dad needed didn’t exist yet. I survived because the medication I needed did. That contrast is the entire point. The families waiting on tomorrow’s treatments don’t need Washington’s slogans. They need breakthroughs. They need affordability driven by abundance, not political shortcuts.
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And they need a government willing to stop sabotaging the very innovators who make these cures possible.
If we fix incentives, unleash competition, and trust free people to innovate, America—not China—will lead the future of medicine. And millions of families will live longer, healthier, and freer lives because of it. That is how we let people prosper.

Originally published on Substack. 

​Another week, another blockbuster story showing why America keeps paying more for “coverage” while getting less actual healthcare. The Wall Street Journal just dropped a devastating investigation into Medicaid’s provider “networks” — and it’s exactly the kind of systemic failure you’d expect when government tries to centrally manage a $900 billion program through giant insurers who get paid whether patients receive care or not.

The headline says it all: Medicaid insurers promise lots of doctors. Good luck seeing one.

This isn’t a glitch. It’s the inevitable result of a government-run system built on incentives that reward paperwork, not healing.

Let’s walk through what’s happening — and why it’s yet another reminder that coverage ≠ care.

​A System That Pretends to Work, Until You Actually Need It

The Journal found something stunning but not surprising: More than one-third of doctors listed in Medicaid networks never saw a single Medicaid patient last year. In psychiatry and other key specialties, almost half saw zero. That’s not a network. That’s a ghost town with a phone directory.

And behind every one of those ghosts is a real family left waiting, pleading, or driving 90 miles for care that should be accessible in their community.

A few examples that hit hard:

• A mother in Illinois desperately searching for a child psychiatrist after her son repeatedly ran away — placed on a 12–18 month waitlist despite dozens of “in-network” options.
• A man in Texas told by every rheumatologist in his plan that they aren’t accepting Medicaid patients. His fallback advice? “Don’t get sick.”
• A baby in East Texas with a rare neurological disorder — forced to travel to Dallas, only to miss the appointment when Medicaid’s ride-share system failed.

This is not a safety net. It’s a web of bureaucratic illusions.

Why This Happens: Bad Incentives, Bad Data, Big Gatekeepers
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Here’s the uncomfortable truth: Medicaid pays providers far less than private insurance.

That means many specialists have to choose between treating a patient at a loss or keeping their doors open. So they do the rational thing under a distorted system: They limit Medicaid slots, or stop taking Medicaid altogether.

Meanwhile:

• Insurers get paid by the state whether patients are seen or not.
• States rely on insurer-reported networks rather than outcomes.
• Directories are filled with misidentified, out-of-state, retired, or long-gone doctors.
• Federal rules focus on maintaining “adequate networks,” not on actual access.

​That’s how you end up with South Carolina counties supposedly full of neurologists who live in Florida, or Texas networks that list nurse practitioners as psychiatrists.

Central planning strikes again!

Coverage Isn’t Care — and It Never Has Been

Medicaid enrollment has exploded in the last decade. Costs have surged. Insurer revenues have soared into the tens of billions.

But none of that magically increases the number of specialists. None of it shrinks waitlists. None of it fixes workforce shortages created by regulations, licensing bottlenecks, scope-of-practice restrictions, and reimbursement ceilings so low that many clinics simply cannot survive.

The result?

A massive program where patients technically have coverage, but practically have access to… nothing. And politicians still pat themselves on the back for “expanding” it.

The Human Cost: Delays, Desperation, and Declining Health

We’re not talking about mild inconveniences. These failures hit the most vulnerable:

• Kids with autism who need psychiatric care now, not in 18 months.
• Patients with fungal meningitis seen by primary-care doctors because specialists are booked until 2027.
• Families forced to choose between a 2-hour drive or no care at all.

When government coverage crowds out private coverage and overwhelms clinics, the people who should benefit most end up at the back of the line. And the tragedy is predictable — because Medicaid is designed to expand enrollment, not solve underlying supply shortages.

We Need a Healthcare System Built on Voluntary Exchange, Not Bureaucratic Promises

If you take one insight from the Journal’s reporting, let it be this: A system based on inaccurate networks, bureaucratic contracts, and centrally dictated prices can’t possibly deliver timely, high-quality care.

People need choices. Doctors need flexibility. Patients need direct access. Markets need freedom to innovate, compete, and meet demand.

We don’t need more “coverage.” We need more care — delivered through a system where providers are rewarded for serving patients, not gaming directories. The big insurers play the government’s game because the money is too good. Families play by the rules and still lose. It’s time to flip the incentives.

The Path Forward

Real reform starts with simple principles:

• Pay directly for care, not intermediaries.
• Remove the regulatory bottlenecks that restrict supply.
• Empower patients with portable dollars in no-limit HSAs and transparent market prices.
• Encourage innovative delivery models outside bureaucratic control.

Healthcare flourishes when people exchange value freely — not when states procure care like they’re buying office supplies. The Journal exposed the façade. Now policymakers need the courage to build something real.
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Don’t miss the WSJ article where you can find the charts above and more stories:

Medicaid Insurers Promise Lots of Doctors—Good Luck Seeing One: https://www.wsj.com/health/healthcare/medicaid-insurers-doctor-networks-appointments-72f9c11f

More soon. Stay well — and let’s keep fighting for a system that actually lets people prosper.

Originally published on Substack. 

​President Donald Trump recently said what millions of Americans already know: healthcare costs too much, and the system is rigged against the people it’s supposed to serve.

He’s right about the problem. Families are being crushed by premiums, paperwork, and politics.
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But the latest “solutions” coming out of Washington—like Trump’s new deal with Pfizer—aren’t a cure. They’re another dose of the poison that got us here.

​Let’s be honest: this isn’t a healthcare system anymore. It’s a bureaucratic maze that exists to serve everything expect the patient.

The average family with employer coverage pays nearly$27,000 annually in premiums before setting foot in a doctor’s office. That money disappears into layers of regulation, compliance, and insurance games—feeding an empire of administrators while patients wait in line and doctors burn out.

America spends $5 trillion a year on healthcare. Roughly half of that—$2.5 trillion—is overhead, not healing. My research with Dr. Deane Waldman calls it BURRDEN: Bureaucratic, Unaccountable, Rigid, Regulated, Distorted, Expensive, and Needless. Seventy percent of it could vanish tomorrow if politicians had the courage to get out of the way.

That’s where Trump’s instincts are right but his methods go wrong.

The Pfizer Deal Isn’t Freedom—It’s Favors

Trump’s direct-to-consumer deal with Pfizer is being sold as a breakthrough for patients. But look closer—it’s Washington business as usual. Pfizer gets publicity, political protection, and a pass on the administration’s new 100 percent tariff on imported branded drugs. Smaller innovators get squeezed, and patients get stuck with fewer options and higher prices. That’s not competition. It’s cronyism.

America doesn’t need another “deal.” We need to dismantle the system that makes such deals possible in the first place.

Price Controls Are Just Another Form of Control

Whether it’s Most Favored Nation (MFN) drug pricing, Medicare “negotiation,” or new Section 232 tariffs, these are all versions of the same failed idea: that government can dictate prices and somehow make things cheaper. It never works.

Cutting prices by force doesn’t save money—it kills innovation. The National Bureau of Economic Research found that forcing a 40–50 percent cut in drug prices would wipe out up to 60 percent of early-stage R&D. That’s roughly 100 new therapies—cures for cancer, Alzheimer’s, and rare diseases—that would simply never exist.

You can’t regulate your way to medical miracles. Incentives matter. When you punish success, you get less of it.

The Human Cost: Financial Toxicity

All this waste and control adds up to financial toxicity. It’s not an abstract phrase—it’s a daily crisis. Parents deciding between an asthma inhaler and the power bill. Retirees cutting pills in half. Medicaid patients waiting months to see a specialist because red tape throttles access.

Every mandate, every cap, every layer of bureaucracy bleeds families dry. And it’s completely unnecessary. The market could fix this tomorrow—if Washington would just let it.

Three Reforms to Heal Healthcare

1. End the employer-based tax exclusion.
   Let workers keep the $300 billion in hidden subsidies now flowing to insurance companies. Those dollars belong to the people who earned them. If workers could use them directly, they’d shop for better care, cheaper coverage, or new cash-pay models that actually fit their needs.
2. Create No-Limit Health Savings Accounts.
   Why should politicians tell Americans how much they can save for medical care? No-Limit HSAs would let families take control, pay directly, and reward providers who offer transparent, competitive prices—like the Surgery Center of Oklahoma, where costs are 60 percent lower than the national average.
3. Free doctors and patients to contract directly.
   Direct Primary Care and private direct-to-market models prove that healthcare works best through voluntary exchange. When you cut out middlemen, you get more time with your doctor, lower costs, and real relationships—not forms and frustration.
   
   

Compete to Win

While America ties itself in red tape, other countries are racing ahead. China’s state-driven biotech push aims to dominate the next generation of cures. But the real danger isn’t China’s ambition—it’s America’s surrender. If we keep copying socialist systems and smothering innovation at home, we’ll lose the edge that made us the world’s leader in medicine.

The answer isn’t to control prices lower—it’s to unleash competition so we can out-innovate everyone else. Let patients buy across borders. Let entrepreneurs build clinics and drug companies without begging bureaucrats for permission. The freer we are, the healthier we’ll be.

The Cure: Freedom, Not Force

Trump is right to call out the problem. But real reform means more freedom, not more control. End the employer-based tax distortion. Give workers direct ownership of their healthcare dollars. Open up competition through No-Limit HSAs and voluntary direct-care models.

Do that, and prices will fall, innovation will soar, and patients will finally get the care they deserve—without waiting lines or bureaucratic permission slips.

Healthcare isn’t broken because markets failed. It’s broken because markets were never allowed to work. It’s time to let markets heal.

Thanks for reading, friends.

For more details, see my new co-authored book with Dr. Deane Waldman, Empower Patients: A Cure for America’s Healthcare System, and deeper-dive research ant ATR’s Empower Patients Initiative.
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Visit VanceGinn.com for more of my commentaries, podcast episodes, and resources—and as always, let’s keep working together to let people prosper.

Originally published on Kansas Policy Institute. 

Governor Laura Kelly’s Healthcare Access for Working Kansans (HAWK) Act was sold as a “middle-of-the-road” plan to expand Medicaid to 150,000 more Kansans when it was introduced during the 2025 legislative session. But there’s nothing moderate about growing a failing federal program that already leaves millions of patients nationwide waiting in line for care. Expanding bureaucracy isn’t compassion — it’s doubling down on what’s broken.

As I explained recently in my column at the American Institute for Economic Research’s The Daily Economy, America’s healthcare crisis isn’t a market failure — it’s a government failure. The U.S. now spends nearly $5 trillion a year on healthcare, almost one-fifth of the entire economy. But half of that spending never reaches a doctor or a patient. It disappears into what Dr. Deane Waldman and I call BURRDEN: Bureaucratic, Unaccountable, Rigid, Regulated, Distorted, Expensive, and Needless costs.

Our research finds that as much as $2.5 trillion in annual waste is spent on paperwork, compliance, and red tape — not on care. Those dollars don’t heal anyone; they feed bureaucracies. Expanding Medicaid in Kansas would only make this worse by adding more layers of administration without improving access to doctors.

The Myth of “Coverage”

Governor Kelly argues that expansion will “protect rural hospitals” and “ensure affordable care” by bringing billions of federal dollars to Kansas. But coverage does not equal access. Nationwide, more than 80 million Americans are enrolled in Medicaid, yet many can’t find a doctor who will take them. Reimbursement rates are so low that fewer physicians accept new Medicaid patients — especially in rural areas. Those who do are overwhelmed, leading to long waits.

This is what we call death by queue: a Medicaid card promises care, but patients wait months for appointments while their conditions worsen, or even result in death. Adding 150,000 Kansans to this system won’t shorten the lines; it will lengthen them.

Kelly also claims expansion will “create 23,000 new jobs.” But history shows most of those jobs will be bureaucratic — not medical. The Bureau of Labor Statistics projects that medical administrators will grow 23 percent over the next decade, compared to just 3 percent for physicians. America is producing more paper-pushers than healers. That’s not a sign of success — it’s the symptom of a broken system.

Medicaid Expansion Crowds Out Care

Kansas already spends more than 20 percent of its state budget on Medicaid, diverting resources from priorities like education, infrastructure, and tax relief. The HAWK Act would deepen that dependency, tying Kansas more tightly to Washington’s mandates and debt.

Supporters claim the program will be “free” to Kansans because of federal matching funds. But those funds come with strings attached — and they won’t last. When the federal share drops, Kansas taxpayers will be left footing the bill for a larger, slower, and less effective bureaucracy.

Worse, expanding Medicaid doesn’t just harm state finances. It harms innovation. By imposing government-controlled prices and rules, Washington discourages investment in new treatments and technologies. A study from the National Bureau of Economic Research shows that price caps can slash early-stage drug R&D by up to 60 percent — meaning fewer cures and longer waits for patients.

A Better Path: Empower Patients

​There’s a better way forward — one that restores access, affordability, and accountability without expanding bureaucracy. The Empower Patients Initiative, which I co-authored with Dr. Waldman, lays out reforms that could transform Kansas’s healthcare system by freeing it from federal micromanagement:

• No-Limit Health Savings Accounts (HSAs): Let Kansans save and spend their own healthcare dollars tax-free, without arbitrary caps. 
• Medicaid Block Grants: Give Kansas the flexibility to tailor its own system — integrating Direct Primary Care networks and local clinics that better serve rural areas. 
• Direct Patient-Doctor Relationships: Cut out middlemen like insurance companies and government billing schemes so doctors answer to patients, not bureaucrats. 
• Transparency in Pricing: Encourage hospitals to post real prices upfront, as successful private models like the Surgery Center of Oklahoma already do. 

If we cut BURRDEN in half, $1.2 trillion could be redirected nationally from bureaucracy to patients and providers. That would reduce family costs, raise take-home pay, and expand access to care — all without growing government or debt.

The Moral Case for Kansas

This debate isn’t abstract. It’s about Kansans forced to choose between prescriptions and groceries, about rural families losing access to care, and about doctors burning out while administrators multiply. The moral case is simple: stop rationing by bureaucracy and give patients the dignity of choice.

Healthcare should not be a government favor distributed by politicians. It should be a service exchanged freely between people: doctors and patients. Expanding Medicaid won’t fix Kansas’s healthcare system — it will expand its problems. If lawmakers truly want to expand care, they should empower patients, not bureaucrats.

Originally posted on Spectator World. 

President Donald Trump’s new partnership with Pfizer to sell drugs directly to consumers is being cast as a major win for patients. He’s right about the problem: healthcare and prescription drugs cost too much.

Families are struggling, and patients often face heartbreaking choices between groceries, rent and the medicines they need. But the proposed solution isn’t tackling the root of the issue. It risks exacerbating federal government failures that created this problem.

For starters, Pfizer is claiming that this new campaign is about lowering consumer costs. But it’s really about creating a cozy relationship with the government that nobody else can. Pfizer will gain special government profits, no-charge marketing from the most powerful voice in the world, and, perhaps most importantly, avoidance of the administration’s 100 percent section 232 tariffs on branded drug imports.

​This is good for Pfizer’s investors, but it hurts the overall market, especially for smaller competitors and many patients. Imagine what that will do to an innovative company researching and developing a better, more affordable life-saving drug. It’ll deny that company opportunity, reduce drug supply for consumers, increase drug prices and disrupt drug supply chains.

In short, patients will pay more for worse access to critical drugs, even if the government-mandated direct-to-consumer plan does everything Pfizer and Trump say it will.

Then there’s the simple math on how much this new relationship could, under the most optimistic scenario, save consumers. The answer is… not much.

We spend about $5 trillion annually on healthcare. That staggering number is not just about doctors, nurses and medicines. As much as half of it – $2.5 trillion – is consumed by overhead: paperwork, compliance systems, licensing, mandates and bureaucratic red tape. Most of that has nothing to do with caring for patients, as at least 70 percent of these costs are likely wasted.

Retail and non-retail spending on prescription drugs account for about 15 percent of overall healthcare spending, totaling around $750 billion annually. Apply the same waste factor, and you get more than $260 billion of unnecessary costs tied up in regulation and bureaucracy. That is nearly two times the entire generic drug market of $139 billion, which is less than 20 percent of spending on prescription drugs.

So, even if the Trump-Pfizer agreement can save people 10 percent on generic drugs, it won’t make much of a difference to their bank accounts. The real financial challenges arise when more expensive, life-saving drugs are needed. And yet it’s those life-saving drugs that make up almost the entire debate surrounding the rising cost of prescription medications.
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This “deal” isn’t a solution, just like the Medicare “negotiation” or the Most Favored Nation (MFN) Executive Order “solutions” didn’t solve any real problems. They simply followed the long-held, bipartisan pattern of inserting government even more into how drugs are made.

The path forward isn’t complicated, but it does require courage to take on Washington’s bureaucracy and other rent-seekers who want to create barriers for competition. If Trump – or others – wants to help make healthcare affordable while ensuring America remains the world’s leader in medical breakthroughs, the focus should be on deregulation.
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That means eliminating the 70 percent of healthcare costs that fail basic cost-benefit tests, resisting new price controls like MFN, streamlining FDA approvals to speed up generics and biosimilars and restoring real competition throughout the system. On the demand side, giving patients more control through No-Limit Health Savings Accounts and private direct-pay or direct-to-consumer approaches could introduce the price discipline that nearly every other market enjoys.

​America doesn’t need gimmicks or more central planning. It needs the freedom to innovate, compete and deliver care efficiently. Patients deserve a system where costs reflect value, where new drugs reach the market quickly and where politics don’t suffocate innovation.