The Disease Is the Law, Not the Bureaucrats
Firing Food and Drug Administration officials gets headlines. It does not repeal the Federal Food, Drug, and Cosmetic Act, the Public Health Service Act, or the thousands of pages of enabling regulations that let those officials decide which treatments live and which die. The libertarian case for healthcare reform was never about swapping one set of regulators for another. It was about taking power away from Washington and returning it to patients, doctors, and the entrepreneurs who want to serve them.
Robert F. Kennedy Jr. arrived at the Department of Health and Human Services promising to end chronic disease and clean house at the FDA. His supporters cheered. His critics panicked. Both sides missed the point. The FDA did not accumulate its power because the wrong people sat in Maryland offices. It accumulated power because Congress handed it broad discretion, then refused to take responsibility for the results. Americans spent $4.8 trillion on healthcare in 2024, according to the Centers for Medicare and Medicaid Services. That sum reached 17.6 percent of gross domestic product. No amount of personnel turnover at one agency will bend that curve.
The deeper problem is what public-choice economists call regulatory capture. Large hospitals, drug makers, and insurance companies lobby for rules that look like patient protections but function as barriers to entry. The FDA approved 50 novel drugs in 2024, down from 71 the year before, per the agency's own data. Startups without armies of compliance lawyers struggle to survive the process. Patients wait years for treatments already available in Switzerland, Japan, or Israel. This is not market failure. This is government failure dressed in a white coat.
Kennedy's own rhetoric sometimes promises a smarter FDA, not a smaller one. That is the trap. A smarter FDA still decides whether a small biotech can bring a cancer therapy to market. It still controls what doctors may say about off-label uses. It still protects the large players who can afford the delay. The reform we need is structural, not cosmetic.
Certificate-of-Need Laws Hide the Real Cartel
State politicians love to blame Washington for high prices, but some of the worst offenders sit in state capitals. Thirty-eight states and the District of Columbia still enforce certificate-of-need laws that require healthcare providers to get government permission before adding hospital beds, imaging machines, or surgery centers. The Mercatus Center at George Mason University estimates these laws raise healthcare spending by 3 to 5 percent while reducing access in rural counties. They are an explicit cartel, and they persist because incumbent hospitals fund the politicians who protect them.
Small business owners understand this game. The Small Business Administration reports that firms with fewer than 500 employees make up 99.9 percent of American businesses. Yet a would-be clinic owner in a CON state must prove a "need" to regulators who take their cues from established competitors. That is not competition. It is a conspiracy between government and industry against the consumer. Direct primary care practices, which bypass insurance by charging flat monthly fees, have grown to roughly 1,500 locations nationwide despite these obstacles. Imagine how many more would open if states stopped treating medical services like taxi medallions.
The same dynamic shows up in scope-of-practice rules. Nurse practitioners can safely prescribe medication and manage chronic conditions, but many states require physician supervision. The Federal Trade Commission has repeatedly warned that such restrictions reduce access and raise prices. They do not improve outcomes. They protect guilds. A free economy does not let one profession use the state to block another from competing.
Telemedicine offers another example. During the pandemic, federal and state regulators loosened rules so patients could see doctors by video. Costs fell. Access rose. Then the old lobbies went to work. Many states restored restrictions on out-of-state physicians. They claimed to protect patients. They protected market share. The lesson is clear. Any reform that does not shrink the power to restrict will be clawed back once the emergency fades.
What a Free Market in Medicine Would Actually Look Like
Healthcare does not need a new czar to manage prices from a desk in Washington. It needs fewer czars, more price transparency, and the freedom for patients and providers to make deals without a regulator standing between every diagnosis and every payment. The first step is price transparency. The Trump-era hospital price transparency rule took effect in 2021, yet the Government Accountability Office found in 2024 that most hospitals still do not fully comply. Patients cannot shop if they cannot see prices. Congress should strengthen penalties and extend transparency to drugs, devices, and physician services. A real market requires real information.
The second step is reciprocity. A drug approved by regulators in Germany, Britain, or Japan should be presumptively available to American patients. The RESULT Act, introduced in prior Congresses, would have created that pathway. It went nowhere because the pharmaceutical lobby prefers the current system, where Americans subsidize global research while paying the highest prices on earth. Policymakers who claim to care about patients should pick up that bill again.
The third step is to let Americans buy health insurance across state lines and form association health plans. The 2018 expansion of short-term limited-duration plans was a start, but it was attacked and narrowed. Entrepreneurs should be able to design coverage for gig workers, young families, or faith communities without satisfying every mandate written for Fortune 500 plans. Deregulation is not heartless. It is the only policy that has ever made a complex service affordable at scale.
Kennedy's FDA shakeup may expose waste and arrogance. Good. But cheering a personnel change while leaving the statutory machinery intact is like replacing a broken traffic light while keeping the road closed. The libertarian prescription is simpler than the regulators want to admit. Stop protecting incumbents. Let providers compete. Let patients choose. The price of healthcare will fall. The quality will rise. And the politicians who claim they solved the problem will finally have to find a new applause line.
