11/17/2025
My first patient was a no-show this morning. I have been increasingly annoyed with Congress, the shutdown, insurance costs, etc. This is how I used the time. ChatGPT was much more polite than I was. You are more than welcome to copy and send to your representatives and senators. I cross-posted to my private page.
Dear [Representative/Senator] [Last Name],
I am a Family Medicine physician practicing in a direct primary care (DPC) model in Bentonville. In my practice, for less than $1,200 per year, my patients receive comprehensive primary care that covers over 90% of their healthcare needs, without copays, deductibles, or surprise bills. My husband and I are also DPC patients; together, we pay less than $2,000 per year for unlimited access to our physician, all without additional costs.
In contrast, our 2025 marketplace insurance premium will exceed $2,000 per month, which is now more than our mortgage payment. Over the past six years, my husband and I have paid over $110,000 in health insurance premiums. In that time, our insurer has paid out less than $5,000 total toward medical services on our behalf. Every medical expense we have incurred has been out-of-pocket because we have never met our $8,750 (each) deductible. Functionally, we have been paying luxury prices for a catastrophic plan.
I believe in capitalism, but capitalism cannot function without competition. Under the current system, there is effectively no competition in health insurance. Insurers operate with minimal checks on premium increases, as long as they meet the 15-20% medical loss ratio requirement. Basic math makes it clear why premiums continue to rise: 20% of $100 is far less than 20% of $1,000. As long as payouts exceed the 15% or 20% requirement companies are allowed to increase the rate of the premium. It is in insurers’ best interests for healthcare prices to remain high and continue to rise, and for pricing to remain opaque, and for consumers to remain unaware of how affordable primary care becomes when insurance is removed from the local physician interactions and routine services.
Meanwhile, upper-level insurance executives, often not even the CEO, collect annual salaries that exceed my clinic’s gross revenue. Despite this, my clinic is financially sustainable while providing high-quality, relationship-driven care at a fraction of the cost of traditional insurance-based primary care. The same is true for my own DPC physician. The value problem is not with physicians or primary care - it is with the design of our insurance system.
I urge you to consider the following reforms to restore competition and lower healthcare costs:
1. Allow health insurance to be sold across state lines to increase competition and reduce regional monopolies.
2. Incentivize employers to end the practice of tying health insurance to employment. This practice dates back to World War II, when companies were competing for a greatly reduced workforce. Companies offered health insurance instead of pay raises during WWII because: a. Wage controls prevented salary increases. b. Benefits didn’t count as wages, so they were a legal workaround, and c. IRS tax rulings made employer-provided insurance financially attractive. This WWII workaround is exactly why our modern employer-based health insurance system exists today.
Instead, allow employers to pay employees directly for healthcare -letting individuals choose how to allocate those healthcare dollars.
3. Finally, ensure that members of Congress have access only to the same insurance options available to their constituents. Policies improve when policymakers directly experience their consequences.
These changes would create a market in which insurers must compete rather than dictate terms.
As someone who cares deeply for my patients and witnesses firsthand how cost barriers and high deductibles harm them, I believe these reforms are essential to making healthcare affordable and accessible in the United States.
Thank you for your attention to this issue and for your service to our state. I would be happy to discuss these ideas further or provide additional insight from the perspective of a front-line primary care physician.
Sincerely,
Kimberly Chapman, MD
