I don’t go to the doctor often. But when I do, I expect to be able to see one without waiting nearly a month.

Unfortunately, that’s not the case with Kaiser Permanente in Northern California, where I get my healthcare coverage through my employer. Despite paying $2,770 every month for health insurance covering a family of four members — yes, you read that right — I routinely wait 3 to 4 weeks to see even a primary care physician now in east bayarea. Before COVID, I could usually see my physicians within a few days or at most 2 weeks.

So what exactly am I — and millions of others — paying for?

🔍 The Numbers: How Bad Is It Really?

Let’s break it down.

  • Monthly Premium:

    To cover a family of four members, I pay $224 every two weeks directly out of my paycheck.

    My employer contributes another $1,054.23 every two weeks.

    → That’s $2,770/month in total for my family of four.

  • What It Buys Me:

    • Wait times of 3–4 weeks for most non-urgent visits

    • Co-pays of $25–$35 per visit

    • Very limited access to outside specialists or second opinions

    • Often rushed appointments with overworked doctors

🧯 This Isn’t Just Me — It’s a Systemic Problem

This isn’t a personal grudge. It’s a widespread failure of a high-cost, low-access system:

  • The average family premium in the U.S. was $2,131/month in 2024 (grew by 7%). My Kaiser plan’s $2,770 is 30% higher than the national average【source: KFF Employer Health Benefits Survey】.

  • Average wait times for a primary care appointment in major U.S. cities?

    20.6 days — and climbing. Across five specialities, there is a 26.0-day average wait time【source: Merritt Hawkins Survey】.

  • Doctor burnout is surging, with nearly 53% of physicians reporting burnout in 2023【source: Medscape National Physician Burnout Report】 — driving shorter appointments, rushed care, and rising turnover.

🧠 Why Is This Happening?

Several causes are behind this contradiction between high cost and low service:

  1. Administrative Cost Bloat:

    A huge chunk of healthcare spending goes to administrative overhead. Administrative spending is estimated at 15–30% of total U.S. healthcare spending, with at least half deemed “ineffective” (not contributing to health outcomes). U.S. healthcare administrative costs are 4x higher than other developed countries like Canada or the UK【source: Health Affairs】.

  2. Provider Shortages:

    The U.S. faces a growing shortage of primary care physicians (PCPs), projected to reach 17,800–48,000 by 2034 (Association of American Medical Colleges, 2020). Northern California has a primary care desert, even in affluent suburbs like mine (east bay area). The Permanente Medical Group (TPMG)’s 9,000+ physicians in Northern California (as of 2024) serve 4.5 million members, but the ratio ( ~1 PCP per 2,000 members) strains capacity during demand spikes.

  3. Population Growth and Aging:

    Northern California’s population (e.g., Bay Area, Sacramento) has grown, and the aging population requires more frequent primary care for chronic diseases. Kaiser’s 4.5 million members in Northern California include a significant proportion of older adults, increasing demand.

🧩 Why the Free Market Hasn’t Fixed Healthcare (Yet)

In theory, the free market solves inefficiencies through competition, innovation, and consumer choice. But U.S. healthcare is not a functioning free market — it’s a heavily distorted quasi-market where normal rules of supply and demand are suspended.

Here are the core distortions through a free-market lens:

❌ 1. No Price Discovery

In a functioning market, consumers know prices and can compare value. In U.S. healthcare:

  • Prices are hidden or meaningless (often vary by 10× between hospitals for the same service).

  • Insured patients rarely know what they owe until after treatment.

  • Providers, payers, and middlemen (like pharmacy benefit managers) obscure pricing through complex billing codes and negotiated rates.

🧠 Market theory insight: Without transparent prices, competition cannot function.

❌ 2. Consumer Cannot Act as Rational Agent

  • Most patients don’t choose their insurance — their employer does.

  • Even if you wanted to switch, networks restrict your provider choices, and switching plans means navigating a maze of red tape.

  • Medical emergencies make it impossible to “shop around.”

🧠 Market theory insight: Without real consumer agency, demand signals are weak or misaligned.

❌ 3. Entry Barriers Prevent New Supply

  • New hospitals or clinics often require government approval via Certificate of Need (CON) laws — anti-competitive relics that protect incumbents. Critics-including the U.S. Department of Justice and Federal Trade Commission-argue that CON laws create barriers to entry, protect incumbent providers, stifle innovation, and limit consumer choice. Incumbent providers can often participate in the CON process and object to new entrants, which can delay or block competition and maintain local monopolies.

  • Medical residency slots are capped by federal funding, artificially limiting physician supply despite demand. The cap was established by Congress in 1997, effectively freezing the number of Medicare-funded residency positions at that time. Since then, only small, incremental increases have been approved, such as the addition of 1,000 new slots in recent years, distributed at a rate of no more than 200 per year. This cap means that even as medical school enrollment has increased, the number of residency positions has not kept pace, leaving some medical graduates unable to complete the required training to become practicing physicians. As a result, the supply of new doctors entering the workforce is constrained by federal funding limits, not by the actual demand for physicians or the capacity of medical schools to produce graduates.

  • State-by-state medical licensing restricts skilled providers (like nurse practitioners) from practicing to their full training. California, for example, is a restricted practice state, meaning NPs there cannot practice to their full training without physician oversight. These state-by-state variations mean that many NPs face legal barriers that prevent them from delivering care at the level they are trained for, particularly in states with reduced or restricted practice environments

🧠 Market theory insight: Supply is artificially constrained — entry barriers destroy competition.

❌ 4. Third-Party Payer Problem

  • When someone else (insurer or government) pays for your care, you lose the incentive to shop for value.

  • Providers cater to insurers — not patients — and billing is optimized for insurance reimbursement, not efficiency or outcome.

🧠 Market theory insight: Third-party payment introduces moral hazard and eliminates price discipline.

❌ 5. Consolidation and Monopoly Power

  • Hospital mergers, insurer mergers, and vertically integrated systems (like Kaiser) reduce competition and raise prices.

  • In many cities, 1–2 hospital systems dominate the market and can set prices without fear of losing patients.

🧠 Market theory insight: Monopoly or oligopoly conditions neutralize competitive pressure.

🛠️ A Free Market Roadmap to Fix Healthcare

To fix healthcare, we must restore market conditions: price transparency, consumer choice, low entry barriers, and aligned incentives. Here’s what that looks like:

✅ 1. Price Transparency

  • Require all hospitals, clinics, and insurers to publish standardized, bundled prices for procedures.

  • Enforce existing transparency laws (many are ignored today).

  • Let patients compare cost and quality like they would for airlines or hotels.

🎯 Outcome: Informed consumers = real competition = lower prices, better value.

✅ 2. Portable, Individual-Controlled Insurance

  • Decouple insurance from employment.

  • Promote Health Savings Accounts (HSAs) and individual market plans that people can shop for on open exchanges.

  • Support catastrophic-only insurance models paired with cash-pay for routine care.

🎯 Outcome: Insurance becomes a consumer product, not a job perk.

✅ 3. Unleash Provider Supply

  • Eliminate CON laws that block new clinics or imaging centers.

  • Expand medical residency funding and allow more foreign-trained doctors to practice with proper vetting.

  • Allow nurse practitioners and physician assistants to practice independently in more states.

🎯 Outcome: More supply → lower prices, shorter wait times.

✅ 4. Enable Interstate Competition

  • Allow insurance and telehealth providers to operate across state lines.

  • Let practitioners serve patients nationwide, especially through virtual care platforms.

🎯 Outcome: Larger market = more competition = innovation and better access.

✅ 5. Promote Cash-Pay, Transparent Clinics

  • Encourage Direct Primary Care (DPC) and surgical centers of excellence that operate on cash or fixed-fee models.

  • Exempt low-cost, transparent care models from the most burdensome regulations.

🎯 Outcome: Competing models force legacy systems to improve.

✅ 6. Align Payment with Outcomes

  • Move away from “fee-for-service” billing to value-based care, where providers are rewarded for improving health, not for doing more procedures.

  • Leverage AI to guide evidence-based care and reduce unnecessary spending.

🎯 Outcome: Incentives drive real results, not volume.

🚨 This Is a Wake-Up Call

We are reaching a breaking point: middle-class professionals are paying thousands per month and still can’t see a doctor in a reasonable time frame. This isn’t sustainable, and it isn’t fair.

📣 Join the Fight for Smarter Healthcare

I’m writing this not just to vent, but to call on engineers, doctors, entrepreneurs, and policymakers to take this seriously.

America’s healthcare system is bloated, inefficient, and opaque — and even highly paid professionals are getting ripped off.

Let’s build tech-empowered, patient-centered models that make health access as fast, transparent, and intelligent as modern tech industry or online shopping.

If we don’t fix this — who will?