Title: Sixteen Years After Obamacare: How Command‑and‑Control Medicine Failed—and How Free Markets Can Still Save American Health Care
On March 23, 2010, the Affordable Care Act—better known as Obamacare—became law. Its architects promised a new era of accessible, affordable, and high-quality health care for every American. Sixteen years later, the verdict is in: those promises were not hallowed, but hollow.
Physicians and patients alike now inhabit a system that frustrates rather than heals. Surgeons routinely face backlogs that push routine elective procedures months into the future. Patients wait weeks to see a specialist for chronic but manageable conditions like atrial fibrillation. Cancer patients are shuffled like parcels between oncologists, radiation specialists, and hospital administrators. Emergency rooms—once intended for true emergencies—overflow with people who can’t get a timely appointment with a primary care doctor. Large hospital systems quietly profit from this dysfunction, since emergency visits often reimburse at three or four times the rate of a standard office appointment.
The result is predictable: salaried physicians are subtly discouraged from seeing more patients, and overall physician productivity has fallen to a 20‑year low. Every stakeholder in the system feels trapped.
The Economics of Scarcity: None of this should surprise anyone who understands economics. In any socialized sector—be it food production, manufacturing, or medical care—the distribution of scarce resources must eventually be managed through central control. Keynesians and their modern heirs have only two basic tools for this: restrict access or fix prices. Whether through rent controls, Soviet grain silos, or bureaucratic rationing of operating room time, the effect is always the same. Scarcity deepens, inefficiency multiplies, and billions (or trillions) in potential wealth evaporate.
Health care is no exception. Instead of expanding access, Obamacare has tightened bottlenecks, distorted incentives, and made care less personal and less efficient.
A Glimpse of Market Reform: On February 5, President Trump made what may prove to be a pivotal move in reversing this dynamic. By launching TrumpRx.gov, the administration opened a direct window into pharmaceutical pricing. Rather than imposing new price controls, the initiative allows patients to view real-time drug costs without interference from the usual middlemen—hospital conglomerates, insurers, and pharmacy benefit managers.
The goal is simple: transparency and competition. As prices fall through open-market competition, insurers will have both the motive and the means to cover co-pays or even pay entire prescription costs outright. It’s a classic case of empowering the consumer rather than the bureaucracy—and it works.
The Rise of Direct-to-Patient Medicine: Meanwhile, a quiet revolution is unfolding at the grassroots level. Direct marketing of home health kits is giving patients new autonomy over basic care. These kits, often stocked with antibiotics, antivirals, and first‑line medications, allow people to manage routine conditions without running to the emergency room.
At the same time, new medical “exchanges” are emerging that look strikingly like freight “load boards” used in the trucking industry. On these digital platforms, patients can search for available appointments, compare prices, and select physicians or specialists based on quality and timing. The technology brings buyers (patients) and sellers (providers) together directly, cutting through layers of middle management.
For obvious reasons, large hospital systems and insurance carriers view these open marketplaces as existential threats. They thrive on opacity, not transparency, on dependence, not independence. But for patients, this transparency restores freedom of choice—the foundation of any functioning market.
The Critics and Their Fears: Predictably, critics from the Keynesian and “command‑and‑control” camps warn of chaos if patients are allowed to “self-prescribe.” They imagine a nation of reckless amateurs misusing medicine without professional oversight.
But this fear is neither new nor historically justified. For centuries, many societies relied on far more open models of medical access without descending into anarchy.
Consider Japan. For much of its history, the Japanese system was pharmacy-driven. Ordinary citizens bought most medicines directly from pharmacists or traditional sellers, treating routine ailments themselves. Prescription-only drug systems are, historically speaking, a modern invention. Japan’s shift came only during and after World War II, when the government enacted the Pharmaceutical Affairs Law of 1943 (restructured in 1948) to regulate narcotics and curb antibiotic abuse. Even then, the shift was motivated more by global modernization trends than by any historical tradition of top-down medicine.
The point is clear: physician‑issued prescriptions as the gatekeeper of all medical access are a twentieth-century innovation, not a timeless necessity.
“Mommy Medicine” and the Loss of Autonomy: In the United States, healthcare institutions now behave like overbearing parents—constantly intervening, second‑guessing, and restricting what patients can do for themselves. We have shifted from a model of empowerment to one of dependence.
Studies estimate that up to 80 percent of emergency room visits do not require specialized care, and that half could be managed at home with basic first‑aid equipment or one of the new direct‑to‑consumer medical kits. Yet patients keep turning to the ER because the system has conditioned them to do so. The modern hospital has become not the apex of care, but a first stop for minor complaints.
A friend of mine, an immigrant from Russia who has lived in the U.S. for six decades, often reflects on this. He built a successful business in my hometown of Columbus, Ohio, and raised two daughters who both became physicians. When we swim together three mornings a week, he tells me of their frustrations—the hours lost to administrative burdens and the patients who rush to emergency care for problems that once were managed at home or in small clinics. “Americans have lost self‑reliance,” he sighs. “Medicine has made them dependent.”
He’s right.
Returning to Freedom—and Functionality: We have not had a truly free market in American health care since the early 1970s. Cost, access, and quality have been managed by committee, not competition. Every reform since has doubled down on control. But the recent steps taken to expand transparency and direct access hint at a way out.
Capitalism, when properly unleashed, has never failed to improve efficiency and quality while driving costs down. Health care should be no different. The self-proclaimed “smart people” of the bureaucracy—Rham Emanuel, Ezekiel Emanuel, and their academic allies—bet that government command could outperform free enterprise. Sixteen years later, the evidence stands against them.
If health care continues to evolve toward open markets—where patients can compare, choose, and even share in cost savings—then the field might at last catch up to every other sector of the economy. Real competition would force inefficiency out, reward innovation, and make access, quality, and cost more than political slogans.
We can still reclaim the freedom to care for ourselves—and to choose those who care for us. Sixteen years after Obamacare, that freedom is the one prescription the American health system has yet to fill.
