“Where have all the flowers gone, long time passing?” sang Pete Seeger in his 1960s protest ballad. If he were singing today, his question might be directed toward America’s healthcare system: “Where have all the care dollars gone, long time waiting?”

The answer is as tragic as it is urgent. In 1965, healthcare spending in the U.S. was 5.6 percent of GDP. Today, it’s 17 percent — over $4.8 trillion a year. That’s more than the entire economy of Germany. Recent projections suggest even greater healthcare overspending in the future. Despite all this money out, Americans face longer waits, higher costs, and declining access to care.

The average maximum wait time to get care, i.e., to see a primary care doctor, now exceeds 130 days. Millions of Americans are struggling to find providers who accept their insurance. In Texas, more than half of doctors won’t take new Medicaid patients.

The most recent “One Big Beautiful Bill” made some incremental progress, including a new Medicaid work requirement for work-capable adults ages 19–55 without dependents. Beginning in January 2027, these beneficiaries must meet a 20-hour-per-week work or training threshold to maintain eligibility.

While well-intentioned — and likely to promote upward mobility — this reform will only be effective if paired with a broader restructuring of Medicaid that ensures dollars actually reach patients instead of disappearing into bureaucracy. The deeper problem isn’t that the government spends too little on healthcare, but that it spends our money in all the wrong places. Over the last few decades, a bureaucratic monster has grown beneath the surface — what we call BURRDEN: bureaucracy, unnecessary rules and regulations, directives, enforcement, and noncompliance.

In 1999,  31 percent of healthcare spending was consumed by this administrative bloat. Today, it’s over 50 percent. That means more than half of every healthcare dollar no longer goes to patients — it goes to paperwork, compliance costs, and layers of federal red tape.

This is not a system designed to serve people. It’s a system designed to serve itself.

From the Affordable Care Act’s thousands of pages of mandates to the Inflation Reduction Act’s drug price-setting schemes, Washington has consistently layered complexity on top of dysfunction. The result isn’t universal coverage or lower costs — it’s an unsustainable, bureaucratic chokehold causing death-by-queue.  President Obama admitted in 2009 that the healthcare cost curve was unsustainable. In 2025, the situation has worsened significantly.

The Centers for Medicare and Medicaid Services project total healthcare spending will top $7 trillion by 2031. At the same time, the Medicare Trust Fund is barreling toward insolvency. Congress already diverted $716 billion from care for seniors to finance the ACA bureaucracy.

Meanwhile, Americans are dying while waiting in line — particularly those covered by Medicaid and Tricare — because the government system can’t deliver care in time to save them.

Between 1970 and 2020, the number of physicians in the U.S. doubled. But the number of non-caregiving bureaucrats ballooned by more than 4,400 percent! This explosion of red tape hasn’t improved outcomes — it has made everything more expensive, less efficient, and less effective.

Doctors are overwhelmed. Hospitals are spending more on compliance than care. And patients are paying the price, sometimes with their lives.

Recreating the Healthcare Marketplace

Fixing this doesn’t require more subsidies or greater central planning. Quite the opposite! It requires trust in markets and individuals. We need to unleash competition among providers, insurers, and innovators by removing regulatory handcuffs.

Instead of employers giving insurance companies an average of $23,968 as “employer-supported health insurance,” give that money (they earned it!) to employees to spend on healthcare costs, both medical and insurance. Let them put those dollars tax-free into an HSA, but that requires Health Savings Account (HSA) reform.

Currently, there are three different versions, each with restrictions, limitations, and federally “allowable expenses.” Repeal them all and replace with a single, simple, no-limit HSA: no limits on time, contributions, or acceptable expenses as long as they are medical. Then, families can shop for care with tax-free dollars and make their own medical as well as financial decisions.

Medicaid should be restructured as block grants to the states, allowing for local experimentation and flexibility, and providing taxpayers and Washington with predictable, sustainable Medicaid spending.

Medicaid was intended for medically vulnerable Americans and children, not for healthy adults. For millions of work-capable adults with no children currently enrolled, benefits should be tied to employment to foster dignity and upward mobility. This worked well for TANF and SNAP and should have similar salutary effects on Medicaid.

We must also confront the artificial scarcity created by state licensing laws. Certificate-of-Need (CON) requirements, for instance, prevent new clinics or hospitals from opening unless they “prove” a need — a protectionist tool that entrenches existing monopolies.

And across the country, entry into healthcare professions is often arbitrarily limited. Becoming a licensed physical therapist, for example, requires a doctorate and over three years of postgraduate training, even though many of the services they provide are routine and could be offered with less schooling, cost, and time. These rules restrict supply, inflate costs, and delay care.

If the U.S. had a real market in healthcare, prices would fall and quality would rise, just as they have in technology, air travel, and retail. Instead, we’ve created a command-and-control system where spending increases and satisfaction declines. Government inserts itself into every transaction — diluting accountability, misallocating resources, and demoralizing professionals.

It’s not too late to change course. But first we must reject the false premise that healthcare is a “right” that Washington must enforce. Healthcare is a personal service — delivered voluntarily by skilled professionals — and best allocated through unfettered commercial exchange, consumer choice, and innovation.

Pete Seeger once asked where the flowers had gone. Today, Americans should be asking where their healthcare dollars have gone. The answer, sadly, is not the exam room or the operating suite, but to the bureaucracy down the hall. It’s time to bring those dollars back to where they belong: with patients, providers, and the families who will die without an effective, timely medical safety net.

READ MORE from Waldman and Ginn:

DOGE Is Missing $2 Trillion in Healthcare Waste

Rage Against the (Healthcare) Machine

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of Center for Healthcare Policy at Texas Public Policy Foundation; former Director of New Mexico Health Insurance Exchange; and author of 13 books, including the latest with Dr. Ginn, “Empower Patients–Two Doctors’ Cure for Healthcare.” Follow him on X.com @DrDeaneW or contact via www.deanewaldman.com. 

Vance Ginn, Ph.D., is president of Ginn Economic Consulting, host of the Let People Prosper Show, and previously chief economist of the first Trump White House’s Office of Management and Budget. Follow him on X.com at @VanceGinn.