Peace in the Middle East was once considered impossible until someone had the courage to take a stand and chart a new course. Mr. President, we need that same clarity and boldness now in health care.

The government shutdown over health care isn’t about medicine, it’s about money. Costs have exploded while premiums skyrocket. Paradoxically, doctors earn less, hospitals consolidate, and patients wait longer. The focus has shifted from healing to billing, with nearly 75 percent of every health care dollar now spent on managing care rather than providing it. Good care has become better, faster, and cheaper than ever before, yet efficiency goes unrewarded and independent physicians are being driven out of business.

Doctors aren’t selling their practices because patients disappeared, but because the cost of compliance and bureaucracy has made independence impossible. Corporate systems now dictate what care is allowed and at what price, turning coverage into captivity. This is health care gerrymandering where third-party administrators create networks designed to limit competition and keep patients trapped. Efficiency is punished, and opaque pricing hides accountability. The result: an unsustainable system.

Presidents have long shaped U.S. health policy. Employer-based insurance began under Truman’s wartime wage freeze. The Affordable Care Act imposed another, forcing Americans to buy coverage and employers to provide it. Workers now surrender up to 29 percent of their wages for plans they rarely use. How can prices rise when doctors are paid less, and patients now recover at home instead of a hospital bed? The true cost of care has fallen, but the price has not, and without transparency, spending can’t be tracked or contained. Job growth will remain anemic until this is fixed.

Hospitals once led by physicians or charities are now run by lawyers, bankers, and developers who see federal health dollars as ways to expand empires, not improve care. They keep building more beds when modern medicine needs fewer. Once beds became commodities, it opened the door to investors, especially private equity, whose model puts profits ahead of patients, not out of malice, but by design. And the result? The worst outcomes of any developed nation.

Imagine if the Joint Chiefs of Staff were replaced by tech CEOs and Wall Street bankers; no one would feel safe. Yet that’s exactly what’s happened in health care: physicians have been pushed out of leadership, and the results speak for themselves.

Access to care is not a privilege; it’s a necessity. And caring for a patient is a privilege doctors still hold sacred. We can fix this, simply and boldly:

• Give the dollar back to the patient: Subsidize people, not bureaucracy. Refund tax dollars into Health Savings Accounts or vouchers. Replace Medicare Part B with a “Medicare Savings Account.” Let Americans decide how to spend their own health care dollars.
• One service, one price, one payment: Doctors should post transparent prices and be paid directly. The market will respond, prices will fall, and accountability will rise.
• Trust doctors again: Most Americans already do. We don’t need bonuses or metrics just prompt, fair payment without interference. Thousands of physicians nationwide already offer direct, transparent pricing.
• End network restrictions: Free markets demand choice. No employer should dictate where a person can receive care.

Health care has been hijacked by administrators and now ranks as the largest employer in 47 states, replacing manufacturing, agriculture, and innovation. Wages have remained flat since the ACA because rising premiums quietly consume every bump in pay. Families could spend that money better on nutrition, education, or saving for the future. Giving Americans their health care dollar back lets them invest in their own health equity, just as homeownership builds financial equity. Paying premiums, by contrast, is like paying rent to a landlord who keeps raising prices while cutting services. Americans deserve a refund and the right to invest in their own care.

So, Mr. President, lead again. Show the same courage that brought peace abroad. Bring peace to health care by restoring the direct relationship between doctors and patients. End the rule of middlemen. Give the dollar back to the patient. Lift the weight off physicians’ shoulders and let us do what we were trained to do and serve our patients.

Only then can America’s health care system finally heal itself from the bottom up. We can do better. We must do better. And with your leadership, we will.

Paula Muto is a vascular surgeon.