Healthcare is the biggest purchase most Americans never really get to make.
One in every twenty dollars spent on earth goes to American healthcare, yet very little passes through the hands of the individual receiving care. It moves between insurance companies, middlemen, hospitals, and drug makers, on their terms.
The stock of our largest insurer is up more than seventy-fold over the last three decades, while medical bills became the leading cause of bankruptcy in the country [1]. That pairing should make us uncomfortable. Yet we tolerate it because healthcare feels too complicated, too entrenched, and too formidable to change.
It’s not hard to see where that belief comes from. Healthcare is the only industry that calls its customers "patients." The word in Latin means “one who suffers or endures” [2], and the system has taken it literally. The lobby at the doctor’s office is called “the waiting room”. Prices are hidden. Calls go unreturned. And the system has little reason to compete for your business because, in most cases, you were never really the customer. Your insurance is how it gets paid.
Most of us get that insurance through work. American employers spend a trillion dollars a year providing that benefit, usually with the best of intentions. But the 26-year-old marathoner and the 58-year-old managing diabetes get the same plan, picked by somebody else, built for the average employee, which is to say, for nobody in particular.
We call this Black Box Benefits. Your employer pays a lot of money into the box. You get an insurance card and wait to see what comes out. Everyone hopes it works when it matters. Meanwhile, the cost of that box keeps increasing. In 2027, employer health costs are projected to rise at their fastest rate since 2003 [3].
Employer-based insurance is an accident of history: a workaround for wage controls during the Second World War, locked in by a 1954 tax ruling, and grown by habit into the way most working Americans pay for their health [4]. We built it. We can build something else.
Healthcare serves whoever controls the dollar. For eighty years, that has been the employer. We think it should be the consumer.
The Sleeping Giant
The American consumer is one of the most powerful forces in the global economy. Give people real choice and purchasing power, and entire industries reorganize themselves around what those people want. That force has transformed travel, retail, entertainment, financial services, and almost every other part of modern life.
There is something strange about trusting people to choose where they live, what they buy, how they raise their families, and how they spend nearly every dollar they earn–while assuming they should have little control over the dollars devoted to their health.
Healthcare is deeply personal. These decisions are about our bodies and our kids. Yet in healthcare, the consumer is asleep. It is time to wake the sleeping giant.
You can already see what happens in the corners of medicine where the consumer is awake. Cost Plus Drugs sells generic medications at transparent prices that are often lower than an insurance copay. Flat-fee family doctors offer long appointments, easier access, and simple monthly pricing. In each case, the provider has to earn one person's business at a time.
The pattern is not subtle. Markets where the person receiving the service also controls the money get better. Markets where a third party pays get worse.
The Role of Health Insurance
The lesson is not that insurance is unnecessary. Insurance is essential. It exists to pool risks no family should have to bear alone, and it should keep doing that. Nobody comparison-shops from the back of an ambulance.
But insurance does not need to control every healthcare decision. Much of healthcare is routine or plannable: the checkup, the prescription, the therapist, the scan, the specialist visit you have known about for weeks. These are places where choice, transparency, and competition can work.
Outside the traditional insurance system, something interesting is already happening. People are buying comprehensive lab panels with their own money. They are wearing devices that track sleep, recovery, glucose, and cardiovascular health. They are paying directly for weight-loss medications, therapy, primary care, and other services they believe will make them healthier.
Something bigger sits underneath those purchases. We are beginning to reject the premise that the time to engage with your health is after you have lost it.
What would happen if the trillions we spend on healthcare every year flowed through the hands of the consumer instead of around them?
The incentives flip. Today, almost every healthcare product eventually has to answer the same question: “Will insurance pay for this?” When the consumer controls the money, the question becomes: “What would be valuable for my health right now?”
Providers have a reason to post prices because the clinic down the street already did. Health plans have to earn your business instead of simply being selected for you by your employer. Entrepreneurs can build products around making people healthier, making care easier, or making it less expensive, and sell them directly to the people who benefit.
The lab panel, the wearable, the flat-fee doctor, and the therapist who is actually right for you stop being purchases made at the edges of the system. They become the system. You stop waiting to find out what the black box will cover and start deciding what your health dollars buy. You become a participant in the market rather than simply the patient.
Today, the only thing most people get to buy is insurance. When the dollars are theirs, they can buy better health. This is the idea behind Thatch.
That is what we mean when we say that people can buy better health, not just better insurance.
Waking the Giant
Thatch inverts the traditional model. Instead of choosing one health plan for an entire company, an employer gives each employee a health budget. The employee uses that money to choose the insurance plan that fits their life.
What’s left can be spent on the care their family actually needs or saved for the future. For one person, that might mean the richest plan on the market to manage a chronic condition. For another, it might mean weight-loss drugs, therapy, fertility care, or a child's braces.
The individual decides how it works for them. Whatever they don't spend stays theirs, building up in a health fund that follows them across years and job changes.
For decades, we have mistaken cost-shifting for consumerism. High-deductible plans were supposed to turn patients into shoppers. Instead, people paying out of their own wages skipped care because a dollar not spent was a dollar kept. Every doctor visit competes with groceries, rent, and everything else.
A health budget changes the incentive. The money is theirs, but it is committed to their health. If they choose a leaner insurance plan, the savings don't disappear back into the system, instead they stay in the fund and grow over time.
The incentive moves from spending less to spending well.
There is a profound difference between saying, “My employer gives me health insurance,” and saying, “My employer gives me thousands of dollars to take care of my health.” One describes a product selected for you. The other describes an asset you control.
Over time, that fund becomes something most Americans have never had: health capital.
It gives people a reason to care about price, quality, and long-term value because good decisions today expand their choices tomorrow. That is what it means to be a health consumer: you have the power to choose your own healthcare.
The End of the Waiting Room
More than 5,000 employers have already made the switch to Thatch. The employers moving to this model are making a simple but powerful bet: that their people know what they and their families need better than any committee ever could.
The goal is not to remove institutions from healthcare. Hospitals, insurers, employers, and doctors matter. The goal is to make all of them answer to the individual again.
Give people control of the dollars, and they stop being the endpoint of the system. They become a force that shapes it. Providers publish prices to compete for them. Insurers work to keep them.
No single decision moves a system this size. But millions of them, pulling in the same direction, shape the system toward the people it was supposed to serve.
A patient suffers. A patient waits. We've done enough of both.
Sources
[2] https://www.etymonline.com/word/patient (Origin and meaning of patient)
[3] Beth Umland, Sunit Patel, "Health benefit costs expected to jump in 2027," Mercer, August 31, 2026. https://www.mercer.com/en-us/insights/us-health-news/survey-health-benefit-costs-expected-to-jump-in-2027/
[4] Blumenthal D. "Employer-Sponsored Health Insurance in the United States: Origins and Implications." New England Journal of Medicine, 2006. https://www.nejm.org/doi/full/10.1056/NEJMhpr060703
