Several years ago, I was working at a physician practice while my wife and I were building our family. Ironically, I was paying roughly $17,000 a year in premiums for a high-deductible health plan. Before receiving much care — and before satisfying a substantial deductible — we were spending $17,000 simply for the privilege of being insured.

There were times I wondered whether we’d be better off putting that money aside and paying physicians directly. But how could we responsibly take that risk? What if my wife became pregnant, complications arose or our child needed emergency care?

I’ve seen the absurdity from the other direction, too. After an emergency room visit, I received a bill based on being self-pay. When I called to provide my insurance information, the revised bill was several hundred dollars higher. I had to laugh. What other industry works like this?

I’ve spent more than a decade working in healthcare, particularly with physician practices. Those experiences have convinced me of a simple principle: Access to medically necessary healthcare should not depend on where you work.

And why should it? If you own a shoe store, your business is selling shoes — not selecting health plans, negotiating premiums and figuring out how your employees will afford medical care.

Whenever universal coverage is proposed, someone asks: How will we pay for it?

But we’re already paying.

Americans spent $5.3 trillion on healthcare in 2024 — $15,474 per person. The Organisation for Economic Co-operation and Development estimates U.S. spending at $14,885 per person, compared with an OECD average of $5,967.

We don’t lack healthcare dollars. We need to spend them better.

Consider this: The nonpartisan Congressional Budget Office has estimated that simplifying payer administration under a single-payer system could save roughly $400 billion in one year alone. Traditional Medicare operates with remarkably low administrative overhead.

Meanwhile, our fragmented private system supports competing networks, contracts, billing rules, prior authorizations, claims systems, denials, appeals, marketing and profits. And providers have to hire people just to navigate all of it.

We spend enormous sums administering how we pay for healthcare instead of providing healthcare.

But I wouldn’t simply put every American on today’s Medicare reimbursement rates. I’d pay providers more.

That is essential. Physicians and hospitals understandably worry that universal coverage means every patient suddenly reimburses at Medicare rates. Private insurers frequently pay substantially more.

So don’t ask providers to take the hit. Use some of the savings generated through administrative simplification, purchasing power and more rational financing to establish reimbursement substantially above today’s Medicare rates — competitive enough that providers want to participate. Then make getting paid simpler: fewer payer rules, fewer denials, fewer prior authorizations and less money wasted fighting for reimbursement.

The goal shouldn’t be cheap government medicine. It should be efficiently financed healthcare that pays providers fairly and covers everybody. Private insurance could remain available for supplemental benefits outside a universal medically necessary package.

Think of the fire department. Imagine your house is burning. Firefighters arrive and ask: Are we in network? Have you met your deductible? Was extinguishing this fire preauthorized?

Of course not. They put out the fire.

If you have cancer, treat the cancer. If your appendix ruptures, operate. If your child can’t breathe, treat your child.

Universal health care costs money. But we’re already spending the money.

The real scandal isn’t simply that American healthcare is so expensive. It’s that we already spend enough to care for everyone, we know better systems are possible, and yet we continue to tolerate one that leaves our most vulnerable neighbors to suffer because they cannot afford to get sick.

When the house is burning, put out the fire. Then figure out the bill.

Cody Leonard is a Virginia Beach healthcare operations professional with more than 13 years of experience with physician practices and healthcare organizations. The views expressed here are his own.