Why Healthcare Needs Markets — and Why Direct Care Is Actually Working

Two recent essays from Sensible Medicine ask an uncomfortable but important question: why do so many healthcare commentators — including physicians — shy away from market-based thinking?

The hesitation is understandable. Health care is emotional. It involves vulnerability, fear, and moral obligation. When costs rise and access feels fragile, “Medicare for All” sounds like an obvious fix: take something that already exists and simply expand it to everyone. What could go wrong?

Plenty, unfortunately.

Medicare itself isn’t a market. It’s a price-setting system layered with billing rules, coding requirements, compliance audits, contractors, and administrative overhead. Expanding it doesn’t eliminate those problems — it scales them. Medicare for All still requires claims processing, documentation, private administrators, and regulatory enforcement. It doesn’t remove red tape; it standardizes it.

Most importantly, it lacks the feedback mechanisms that markets rely on to improve value, efficiency, and affordability. When prices are divorced from choice, and consumers are insulated from cost signals, systems get expensive fast — even when intentions are good.

This is where direct care matters.

Direct primary care doesn’t claim to solve every healthcare problem. It won’t replace hospitals, emergency care, or catastrophic coverage. But it does something no other model consistently achieves: it makes frequent, everyday care so affordable and accessible that it often doesn’t need insurance at all.

Unlimited visits. No copays. Free telemedicine. Simple procedures included. Transparent pricing. Patients can seek care early and often — when problems are smaller, cheaper, and easier to treat.

That alone hits what many policymakers struggle to define: more care, more often, easier access, and lower cost — simultaneously.

Then there’s the quiet disruption most people miss. By stepping outside traditional insurance billing, direct care clinics routinely offer medications and labs at wholesale prices — often 70–95% less than retail or insurance-based rates. That’s not a theoretical reform. It’s happening now, in real clinics, for real patients.

If we’re serious about fixing healthcare costs, the goal shouldn’t be to insure everything. It should be to make most healthcare too inexpensive to insure in the first place.

Markets aren’t heartless. When designed around patients instead of paperwork, they can be deeply humane. Direct care is proof that when transparency, choice, and accountability return, healthcare gets simpler — and better.