11/17/2025
Dr Heagy just sent the following letter off to our state senators and representative. I’d recommend our patients do the same
Dear ———-,
My name is Dr. Lauren Heagy, and I am a Family Medicine physician practicing in a direct primary care (DPC) model in Shrewsbury, PA. In my practice, for less than $1,500 per year, patients receive comprehensive primary care that addresses over 90% of their healthcare needs—with no copays, no deductibles, and no surprise bills.
To illustrate the contrast between affordable direct care and the current insurance landscape, I would like to share real numbers provided by a fellow DPC physician, numbers that mirror the experiences of many families. For 2025, their marketplace insurance premium will exceed $2,000 per month—now higher than many individuals’ mortgage payments. Over six years, this family paid more than $110,000 in health insurance premiums. During that time, the insurer paid out less than $5,000 toward their medical care. Because they never met their annual $8,750 deductible, every medical expense was effectively out-of-pocket. In practice, they paid luxury prices for what amounted to a catastrophic plan.
I believe in capitalism, but capitalism relies on functional competition—and currently, there is effectively no real competition in the health insurance market. Insurers face minimal constraints on premium increases as long as they meet the 15–20% medical loss ratio requirement. The incentive structure is deeply flawed: 20% of $1,000 is far more revenue than 20% of $100. The system rewards rising healthcare costs, opaque pricing, and consumer confusion.
When insurance is removed from routine primary care interactions, the cost of care drops dramatically—but consumers are rarely allowed to experience this reality.
At the same time, upper-level insurance executives often earn annual salaries exceeding my clinic’s total gross revenue. Despite that, my practice—and many other DPC practices—remains financially sustainable while offering high-quality, relationship-driven care at a fraction of the cost of traditional insurance-based primary care. The problem is not with physicians or with primary care itself. The problem is with the design and incentives of our insurance system.
I respectfully urge you to consider the following reforms to restore competition, reduce waste, and improve affordability:
Allow health insurance to be sold across state lines to increase competition and weaken regional monopolies.
Encourage employers to end the outdated practice of tying insurance to employment.
This system was created during World War II—an unintended byproduct of wage controls, IRS rulings, and companies competing for workers without being able to raise salaries. Nearly 80 years later, this workaround continues to bind health insurance to employment in ways that restrict mobility, limit choice, and inflate cost. Employers should instead be allowed to contribute directly to employees’ healthcare costs, enabling individuals to choose the coverage model that serves them best.
Require that members of Congress have access only to the same insurance options available to their constituents.
Policy improves when policymakers directly experience the consequences of the systems they oversee.
These reforms would create a market in which insurers must compete for consumers rather than dictate terms to them.
As a physician who cares deeply for my patients and sees daily how high deductibles, cost barriers, and insurance complexities delay or prevent needed care, I believe these changes are necessary to make healthcare in the United States more accessible, transparent, and affordable.
Thank you for your attention to this issue and for your service to our state. I would welcome the opportunity to discuss these ideas further or to provide additional insight from the perspective of a front-line primary care physician.
Sincerely,
Lauren Heagy, MD
