At Embody Health and Performance, we believe in helping people make informed choices about their care. The information shared here reflects what we’ve found through our own research, education, and experience working within and alongside the healthcare system. We’re not insurance brokers or financial advisors, and this isn’t legal or financial advice—it’s intended to help you better understand your options so you can do your own research and make decisions that fit your life, values, and health goals.
If you haven’t already, start with Blog 1: Rethinking Health Insurance – How to Choose Care That Truly Serves You
Why the “Sick-Care” System Is Broken
For decades we’ve been promised that government reforms and corporate insurance partnerships would “fix” healthcare. The Affordable Care Act (ACA) was sold as that solution—ending pre-existing-condition denials, keeping our trusted doctors, and lowering costs for families by $2,500 a year.
Fifteen years later, the opposite has happened.
- Average annual family premiums climbed from ≈ $13,000 in 2010 to $25,572 in 2024 — a 129 % increase (KFF Employer Health Benefits Survey, 2024).
- Non-ACA individual premiums rose even faster—up 173 % since 2013 (Health Care Cost Institute).
- Average deductibles now exceed $8,000 for families; out-of-pocket maximums add another $9–12K.
The result? Millions of “functionally uninsured” Americans—covered on paper, but unable to afford actual care.
Reason 1: It Prioritizes Billing Codes Over Outcomes
The current model rewards billing codes as much or more than actual outcomes. Providers are reimbursed per procedure or body part rather than per person or hour. That’s why a physical therapist may have to list a shoulder, knee, and spine as separate “cases” instead of addressing how those parts actually work together.
“Sick-care” is transactional, reactive, and fragmented:
- Pre-authorizations delay care.
- Networks restrict your provider choice.
- Short visits and excessive documentation replace conversation and analysis.
- Care plans chase symptoms rather than restoring function.
The system pays for motion, not progress—and that’s a problem.
Reason 2: It’s Controlled by Rent-Seekers, Not Healers
Jeff Danby’s Common Sense Medicine explains this erosion simply: over time, outsiders—insurers, benefit managers, and regulators—inserted themselves between patient and provider, capturing revenue without adding value.
“Doctors have been squeezed out of attending to the needs of their patients and captured into serving these outsiders.” — Common Sense Medicine, p. 8
In economic terms, this is rent-seeking — a process where intermediaries extract profit through regulation and complexity. In human terms, it’s what turned your relationship with your clinician into a paperwork pipeline.
Reason 3: It Hides Prices and Eliminates Competition
In every other market—mechanics, veterinarians, salons—prices are visible before service. That visibility creates competition and trust.
Healthcare lost this “price discovery” because third parties negotiate secret rates and forbid open pricing. When a system hides costs:
- Patients can’t make informed choices.
- Providers can’t align value with results.
- Prices spiral upward without resistance.
The ACA amplified this problem. Subsidies created artificial demand, allowing providers and carriers to raise prices while the government back-filled the gap. Consolidation followed—fewer hospital systems, less competition, higher margins.
Insurer profits soared: UnitedHealth Group’s net income grew 267 % between 2010 and 2023 (SEC 10-K Filings).
Restoring price discovery—through direct care, cash-rate listings, or reference-based pricing—returns fairness to both sides of the exam table.
Reason 4: It Creates the Illusion of Coverage
High premiums and deductibles have given us an expensive illusion of security. Even “gold-level” insurance often covers only procedures that fit within corporate billing frameworks. Preventive or integrative approaches—nutrition counseling, movement therapy, acupuncture, red-light therapy—are sidelined because there’s no CPT code that profits the insurer.
Meanwhile, outcomes continue to decline:
- U.S. life expectancy fell from 77.8 years in 2010 to 76.8 in 2023.
- Obesity rose from ~15 % to 42 % of adults.
- Six in ten Americans live with at least one chronic disease.
Spending more hasn’t made us healthier — because dollars flow to administration, not prevention.
Reason 5: It Punishes Prevention and Rewards Illness
The system treats “sick” as profitable and “well” as unbillable. It prioritizes high-cost interventions over functional restoration and education.
Whole-Human Care flips that script:
- Time-Based Billing — You pay for expertise and outcomes, not codes.
- Transparent Pricing — You know the cost before the session.
- Direct Access — No network hoops or pre-auth delays.
- Collaboration — Care teams coordinate movement, nutrition, and wellness rather than chasing isolated symptoms.
- Prevention First — Healthy patients are not bad for business; they’re the goal.
This is how smaller, out-of-network and membership-based clinics restore both health and trust.
From “Sick-Care” to Self-Stewardship
Reforming the system begins with individual action:
- Choose providers who operate transparently and value time, not codes.
- Ask for up-front pricing or time-based rates.
- Use cash-rate tools such as Turquoise Health or FAIR Health Consumer to compare prices.
- During open enrollment, evaluate if catastrophic or out-of-network-friendly plans serve you better than restrictive HMOs.
- Invest in prevention: functional wellness, physical therapy, movement practice, nutrition—because true health starts before disease.
A Call for Common Sense
As Danby reminds us, medicine worked best when it was local, personal, and accountable. Restoring that simplicity doesn’t require dismantling science—it requires removing bureaucracy.
Whole-human care replaces red tape with relationship. It aligns incentives around healing, not billing. It returns ownership of health to the only two people who should have it: the patient and the provider.
Conclusion
The American healthcare crisis isn’t just about cost—it’s about misaligned priorities. We built a system that profits from illness instead of vitality. The cure begins when patients and practitioners reconnect directly, pricing is transparent, and time—not paperwork—becomes the unit of value.
At Embody Health and Performance, we’re committed to a model that puts people first. Some might think it’s radical. We simply believe it’s the way healthcare should be done—in the best interests of our clients, and in the spirit of helping people live their healthiest, most capable lives.
As always, we encourage you to explore these ideas further, ask questions, and seek professional guidance where needed. The more you understand the system, the more freedom you have within it.
