Empower Texas Patients

Originally published on Substack. 

Yesterday, I submitted written testimony to the Texas House Select Committee on Health Care Affordability with a straightforward message: stop layering new mandates onto a broken system and start rebuilding health care around patients.

That is the foundation of my work at Ginn Economic Consulting, my recent piece Empower Patients, Not Bureaucracies, and the broader Empower Patients Initiative, which I helped advance with Americans for Tax Reform and Dr. Deane Waldman. The same framework is also developed in our re-released book with a different title, Become an Empowered Patient.

The core point is simple: affordable care will not come from empowering more bureaucracies. It will come from empowering patients.

That should be the North Star for Texas policymakers.

Texans do not need another study to know health care is broken. They live it every month through rising premiums, higher deductibles, surprise bills, delayed care, shrinking physician independence, and wages squeezed by employer-sponsored coverage. They see a system with more “coverage” but less affordability, less transparency, and less trust.

That is not a functioning market. It is a heavily distorted system shaped by third-party payment, government favoritism, and bureaucratic control.

Coverage Is Not Care

One of the biggest mistakes in health policy is treating coverage and care as if they are the same thing.

They are not.

A bigger insurance card does not automatically mean better access, lower prices, or stronger outcomes. In practice, the opposite often happens. When patients are disconnected from real prices, doctors are buried in compliance, and payment is routed through layers of insurers and government programs, the system becomes more expensive and less personal at the same time.

That is why serious reform should not begin with “How do we expand bureaucratic coverage?” It should begin with “How do we restore the patient-doctor relationship and let markets work again?”

That is the animating principle of the Empower Patients Initiative: move power away from institutions and back to people.

The Tax Code Helped Create This Mess

One of the most underappreciated drivers of our current system is the federal tax exclusion for employer-sponsored insurance.

That policy helped push coverage into the workplace, hide the true cost of compensation, reward more expensive plans, and disconnect patients from the actual price of care. It encouraged a world where employers, insurers, and government programs make most of the decisions while patients try to navigate the consequences.

That is one reason I argued in Empower Patients, Not Bureaucracies and Solving the Healthcare Affordability Crisis that the real problem is not a lack of bureaucratic oversight. It is a system of warped incentives that suppresses price signals, shields payers from accountability, and leaves patients with less control than they should have.

That is not a market failure. It is a policy failure.

Transparency Helps Only If Patients Can Act

There is plenty of discussion right now about price transparency. Good. People should know what care costs.

But transparency alone is not enough.

What price are we talking about? The hospital list price? The negotiated insurer rate? The Medicare reimbursement? The cash price? The patient’s out-of-pocket estimate? Those can be radically different numbers. So if lawmakers simply require more price posting without changing who controls the dollars and the decisions, transparency becomes one more compliance exercise.

Transparency without ownership is noise.

For transparency to matter, patients need the power to act on the information. That means more direct primary care, more cash-pay options, more flexible health savings arrangements, and fewer barriers blocking real alternatives. That is why the Empower Patients Initiative focuses on restoring buyer-seller relationships in health care rather than just adding new reporting requirements to the old system.

The Reform Agenda Texas Should Pursue

If Texas wants to lead, it should stop trying to patch over a broken structure and instead move toward a patient-centered market.

That means expanding direct primary care and direct doctor-patient contracts. It means reducing mandates that drive up premiums. It means pairing catastrophic coverage with patient-controlled accounts. It means removing barriers to entry so more providers can compete. It means protecting independent physicians from regulatory overload. And it means treating transparency as a tool instead of pretending it is the cure.

I have made that case consistently in Empower Patients, Not Bureaucracies, Solving the Healthcare Affordability Crisis, and Stop Propping Up Obamacare. The common theme is simple: if you keep subsidizing and regulating a broken structure, you get a more expensive version of the same broken structure.

The better answer is more freedom, more competition, and more direct accountability.

Fix Medicaid by Trusting Texans

The same principle applies to Medicaid.

Medicaid is supposed to help vulnerable Texans, but too often it traps them in a system with weak access, low provider participation, and expensive, hospital-centered care. Texas should not define success by how well it processes claims through a bureaucracy. It should define success by whether patients can actually get timely, quality care.

That means pushing for more state flexibility, more patient-centered options, and more room for innovative delivery models outside the usual administrative maze. A Texas model should focus on portable dollars, direct care, community and charitable support, and stronger incentives for responsible use of resources.

Trust Texans more. Trust Washington less.

Don’t Chase Every Villain of the Week

There is also a growing temptation to fixate on individual middlemen, especially pharmacy benefit managers.

They deserve scrutiny. But they are not the root problem.

PBMs are one manifestation of a third-party payment architecture that distorts incentives across the whole system. If lawmakers regulate one intermediary without fixing the underlying money flow, the dysfunction will simply reappear somewhere else.

That is why policymakers should focus less on chasing symptoms and more on repairing the structure itself. Fix the incentives. Fix the payment distortions. Fix the barriers to direct exchange. A lot of the middleman pathology shrinks once patients and doctors regain more control.

This Is Economic and Moral

At bottom, this is not just an economic issue. It is a moral one.

Patients are not billing codes. Doctors are not paper-pushers. Families should not need a bureaucratic decoder ring just to get basic care. A decent health system should be built on trust, choice, responsibility, useful transparency, and accountability grounded in voluntary exchange.

That is why the Empower Patients Initiative matters. It is not just another policy package. It is a shift in orientation away from bureaucratic control and back toward a system that treats people like adults.

That is how we improve access.

That is how we lower costs.

That is how we get better outcomes.

That is how we let people prosper.

Three Takeaways for Policymakers

1. Shift control to patients.

Expand direct primary care, patient-controlled accounts, cash-pay competition, and other models that reconnect people to doctors and prices, as outlined in the Empower Patients Initiative.

2. Fix incentives, not symptoms.

Reduce mandates, unwind third-party distortions, and stop propping up bureaucratic structures that separate patients from care, as I argued in Empower Patients, Not Bureaucracies and Stop Propping Up Obamacare.

3. Use transparency wisely.

Transparency helps only when patients can act on it with real alternatives and more control over their own health care dollars.

Health care reform should start with a simple test:

Does this policy move power from bureaucracies to patients?

If yes, advance it.

If no, reject it.

That is the standard Texas should use.

Thank you for reading, for supporting my work, and for sharing it with others. I’m grateful for the opportunity to keep doing this through Ginn Economic Consulting, helping provide a North Star for policymakers who want sound reforms that actually let people prosper. If you are a policymaker, organization, or media outlet looking to go deeper on these reforms, I am always glad to speak at events, do interviews, join podcasts, and meet with leaders across Texas and the country.
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You can read more at vanceginn.com, subscribe at vanceginn.substack.com, explore the broader reform framework at EmpowerPatients.info, and get the book Become an Empowered Patient.