How to Buy Better Healthcare for Less

Host: Dr. Kat Lindley | Guests: Dr. Mollie James and Christine Price

You can price a car, a house, or a plane ticket before you commit a dollar. Healthcare asks something no other major purchase does: agree to services blind, sign whatever is put in front of you, and learn what it cost weeks or months later, when the bill arrives.

Most of us were taught that insurance is the shield against those bills. Yet premiums keep climbing, deductibles keep growing, and the surprise charges keep coming. This episode of the IMA Weekly Show asks a different question: what if the best way to save money on healthcare is learning how to buy care itself?

This episode pairs two guests who know the system from opposite sides. Dr. Mollie James is a surgeon and critical care specialist who left hospital medicine to build a direct care practice. Christine Price has spent three decades inside the health plan industry, building employer plans without PPO networks and challenging hospital bills line by line. Between them, they map where the money actually goes and how to stop sending it there.

1. The Cost Nobody Can Name

Dr. James traces her disillusionment to a question she asked as a surgical resident: how much does a CBC cost? It’s the most routine blood test in medicine, ordered on nearly every patient, every day. Nobody could answer her. Not the doctors, not billing, not nursing. She only learned the answer years later, running her own cash-pay practice, where patients ask what things cost and the doctor has to know: about three to five dollars.

Christine Price has spent decades cataloging how that opacity works. She described the practices she sees most often when reviewing hospital bills:

• Unbundling: splitting one billing code into several to increase reimbursement
• Facility fees: when a hospital buys a physician’s office, a visit that used to cost $150 to $200 can pick up a $400 to $900 charge just for walking into a building the hospital now owns
• Chargemaster tiers: hospitals maintain a gross charge, a minimum charge, a discounted charge, and a cash charge for the same service, with the gross charge inflated far beyond what anyone actually pays

The result, as Dr. Lindley put it, is bills patients can’t read, where an ibuprofen can show up as an $800 line item. For patients fighting back, Price offered a hard-won tactic: requesting an itemized bill tips the hospital off that a dispute is coming, and she said she has seen records changed after the request.

“Always get your medical records first, and then get the bill once you have the medical records in your hand, because when you request an itemized bill, the hospital senses there’s a dispute coming.” — Christine Price

2. The Discount Illusion

Anyone who has opened an explanation of benefits knows the strange arithmetic: a huge charge, a generous-looking discount, and a balance that still hurts. So where is the money going? Price points to everyone standing in the middle: the broker who sold the policy, administrators charging a percentage of “savings,” and pharmacy benefit managers taking their spread.

“Everybody that stands between a patient and their care is making money.” — Christine Price

The discounts themselves, she argued, are the illusion. A Las Vegas state employee plan was shown a 62% discount off claims; she pulled up one of its hospitals and found a CT scan listed at $21,000, “discounted” to $7,700, still many times what Medicare pays. The same pattern runs at every scale: one of her clients was quoted $5,000 for an MRI an independent imaging center performed for $375.

Dr. James pointed the same lens inside the hospital: physician pay, she argued, has declined for two decades while administrative layers and executive bonuses have grown. The inflated bills are funding administration, not the nurse and doctor at the bedside. And the protection people think they’re buying often isn’t there when they need it.

“65% of people who go medically bankrupt have healthcare insurance. It is not doing the work that you think it’s going to do.” — Dr. Mollie James

3. Employers Hold More Power Than They Realize

If you get your coverage through work, you know the routine: premiums rise, the renewal meeting presents the same shrinking options, and everyone assumes nobody can change it. Price says that assumption is wrong, and the key is how the plan is funded. In a fully insured plan, the company pays a premium and the insurer takes the risk. In a self-funded plan, the company pays the medical bills itself, buys a backstop policy (called stop-loss) for the very largest ones, and, crucially, writes its own rules for what the plan covers and what members pay.

That design power is where the savings live. Price builds plans on reference-based pricing: instead of accepting a network “discount” off an inflated chargemaster number, the plan prices claims at roughly 140% of what Medicare pays.

“You set the prices instead of setting the discount.” — Christine Price

Price added a warning for business owners: the law now holds employers responsible for overseeing what their plan spends, and “my broker handles it” no longer protects them. The questions she says every employer should be asking:

• What fee are we paying to access the network?
• How much commission does the broker earn, and from whom?
• Is anyone in the chain charging a percentage of savings?

Her favorite design move: members pay nothing at all when they use independent doctors, imaging, and labs. Removing that friction, she argued, prevents the ER visits and hospital stays that follow when an employee skips a $150 visit they can’t afford.

4. The Direct-Pay Toolkit

What can patients and employers actually buy outside the insurance system? The panel named names:

• Direct primary care and concierge medicine: membership-based practices with transparent flat fees
• Independent labs and imaging centers: the $375 MRI instead of the $5,000 one
• Transparent-price surgery centers: Price described flying a plan member from Pennsylvania to Oklahoma because the surgical savings paid for the trip many times over
• Finding them: four organizations named in the episode connect buyers with transparent-price providers:
  • Free Market Medical Association, which exists to match healthcare buyers with sellers
  • Surgery Center of Oklahoma, the transparent package-pricing surgical facility co-founded by Dr. Keith Smith
  • AAPS, the Association of American Physicians and Surgeons
  • MedMaps, a searchable directory of integrative clinicians

Where to buy care is half of it; paying for it without traditional insurance is the other. Both experts handle their own care the same way: a direct primary care membership for everyday needs, paired with a health share for the big things.

A health share isn’t insurance. It’s a membership pool: you cover your own smaller expenses up to an amount you choose, and the pool shares catastrophic costs beyond it. Both use Zion HealthShare (neither has any affiliation), and Price cautioned that most health shares exclude pre-existing conditions for the first year or two, so read the terms before you switch.

A health savings account can cover much of the rest. Money goes in untaxed, grows untaxed, and comes out untaxed when spent on medical care. Starting in 2026, that includes the DPC membership itself: up to $150 a month for an individual, $300 for more than one person. A flexible spending account is different: whatever you don’t spend by year’s end is gone.

5. The Missing Piece: Independent Doctors

Demand for this kind of care, Dr. James argued, is no longer the bottleneck. She cited more than 7,000 employers now offering DPC benefits, and made the case that employers are the fastest lever: their adoption could shift the market in one to five years; waiting for patients to discover direct care one at a time could take twenty.

The bottleneck is doctors. Most carry six-figure debt, have no business training, and can’t get a bank to fund an independent practice. Dr. James knows the failure mode personally: her first practice went bankrupt. She had no business plan, and insurance didn’t pay her for roughly two years while she saw patients daily. She went back into the system, then rebuilt as direct-pay with the lessons learned.

That experience is why she founded Maverick Medical Ventures, which handles the business side for physicians going independent: marketing, finance, and operations. Its first live event runs October 15–18, 2026, and will be CME-eligible. Dr. Lindley offered her own proof the leap can be made: she started her practice with $5,000 and her medical school bag.

For Dr. James, the stakes reach beyond economics.

“If COVID happened again tomorrow, we would be in the same boat we’ve been in, because the problem was not that there weren’t good treatments. The problem was 95% of doctors were plugged into a system that threatened their job if they didn’t do what was posted on a piece of paper and get their shots.” — Dr. Mollie James

Learning to Buy Healthcare Better

The closing advice was unanimous: this is learnable. Price wants to put herself out of a job by teaching every employer to buy independent care directly. Dr. James urged viewers to stop making healthcare decisions out of fear. The action point is simple: ask your employer whether they’ve looked at direct-pay plan design, and if not, to find someone who can help. The vendors, Price argued, profit from making it all seem too complex. Peel back the layers, and it isn’t.

Related Reading

• Webinar: The Importance of Independent Medical Practice for Patient Care
• Webinar: How to Start a Private Medical Practice
• Course: IMA Academy
• Website: Maverick Medical Ventures
• Website: High Stakes Healthcare