Direct Subsidies Won’t Fix Healthcare Without Fixing How People Choose

By Erik Wissig, COO, SureCo

President Trump’s proposed Great Healthcare Plan has reignited a familiar debate in U.S. health policy: what happens when more money is pushed closer to the individual? The framework centers on directing healthcare dollars to people rather than institutions. That is a move with intuitive appeal in a system widely criticized for being opaque and misaligned with consumer needs.

But, the assumption embedded in that approach – that individuals are ready to make informed healthcare decisions if given financial control – deserves closer examination.

The reality is that most Americans are being asked to navigate a system they do not understand with tools that were never designed for consumer decision-making. Without addressing that gap, shifting subsidies risks becoming another temporary intervention rather than a structural change.

Subsidies Buy Time, Not Understanding

Temporary subsidies have long been used to soften the impact of rising healthcare costs. They help people stay insured and absorb premium increases, but they rarely change behavior. When extended without a broader strategy, subsidies postpone hard decisions instead of resolving them.

Direct payments, as outlined in the current framework, may follow a similar path. Giving individuals healthcare dollars assumes they know how to evaluate plans, compare networks, understand cost-sharing, and anticipate future care needs. Most do not. Even concepts like deductibles and coinsurance are poorly understood, and network design remains confusing to even experienced consumers.

The frustration many people feel today goes beyond cost and into paying for something they don’t understand or can’t confidently assess for value.

The System Isn’t Built for Consumer Choice

Healthcare plans have become more complex at the same time individuals are being asked to shoulder more financial responsibility. Deductibles are higher, coverage exclusions more nuanced, and benefit designs increasingly layered with conditions and exceptions. Summary documents exist, but standardization hasn’t translated into comprehension.

Meanwhile, providers and carriers continue to operate in a fee-for-service environment that rewards volume and complexity. Negotiations over reimbursement and network participation play out behind the scenes, which leaves consumers disconnected from the real drivers of cost and access.

In that context, simply transferring funds to individuals risks reinforcing existing inefficiencies rather than correcting them.

Choice Requires Alignment Across the Market

For a consumer-driven model to function, participation must extend beyond the individual. Providers have to be willing to present pricing and outcomes in ways people can legitimately compare. Carriers need to design plans that balance affordability with clarity. Employers, whether directly sponsoring coverage or supporting individual purchasing, play a role in helping people navigate options rather than leaving them to fend for themselves.

Some early signals suggest parts of the market are experimenting with this alignment. Cash-pay models, concierge practices, and condition-specific offerings are emerging in response to consumer demand for transparency and predictability. While not universal solutions, they reflect a shift toward meeting people where they are.

Policy can accelerate that shift, but only if incentives are structured to reward participation across all sides of the system.

Technology Can Help, Carefully

There is growing interest in using AI and digital tools to improve healthcare education and navigation. If done well, these tools could help people understand trade-offs and model costs, which positions them to ask better questions before making decisions.

But, caution is warranted. Healthcare decisions carry real consequences. Automation without oversight introduces risk. AI should support confidence and clarity while not replacing human judgment or oversimplifying complex trade-offs. The goal is faster understanding.

Where This Leaves Employers and Individual Coverage

Employers are already grappling with how best to support workers as costs rise and traditional group plans become less flexible. Models that shift purchasing power to individuals while still providing some structure and guidance offer a real-world test of how employees engage with healthcare choices.

An Individual Coverage Health Reimbursement Arrangement (ICHRA) is one example. This allows employers to provide tax-advantaged funds that employees use to purchase individual health insurance plans that best meet their needs.

Experience from these arrangements shows a consistent pattern: confusion rises without guidance, and decision-making improves with clear information, context, and practical tools

A Framework Is Only the Beginning

The Great Healthcare Plan, as currently outlined, faces significant legislative hurdles and open questions around implementation, coverage quality, and unintended consequences. As a framework, it raises familiar ideas about agency and accountability that have already been tested, in limited form, in employer-driven individual coverage arrangements. As policy, however, it will require far more specificity to succeed at scale.

If the goal is a healthcare system that responds to individual needs rather than institutional incentives, then education, transparency, and market alignment are not optional add-ons. They are prerequisites.

Without them, direct subsidies – whether delivered through public policy or employer funding – risk becoming another short-term fix in a system that continues to ask people to make decisions without giving them the means to fully understand them.

About Erik Wissig

Erik Wissig, COO and CFO of SureCo, is an ICHRA pioneer and innovator. In 2013, he co-founded Hixme, where he and his team created the country’s first group-to-individual health insurance model. They led the lobbying efforts that facilitated the current ICHRA regulations and built the technology to support it. Upon teaming up with SureCo in 2020, Erik quickly initiated and spearheaded the acquisition of Hixme and launched SureCo’s ICHRA business.

Erik has 25+ years of experience at the intersection of healthcare and technology. He began his career in investment banking, where he advised both private and public companies on a variety of corporate transactions, including M&A and capital raising. He earned his degree in Business Economics and German from the University of California at Santa Barbara and achieved the Chartered Financial Analyst designation from the CFA Institute.