Recent polling from the West Health-Gallup Center revealed a troubling reality. Roughly one-third of Americans reported having cut back on spending to afford medical care, with consequences ranging from delaying retirement to skipping vacations and meals. These results reveal a deeper truth about how the system has changed. Insurance no longer acts as the shield it once did, and most Americans now pay out of pocket for their care. Like it or not, we are all cash payers now.

It wasn’t always like this. In 2009, the year before Obamacare was passed, the average annual premium for employer-sponsored insurance was $4,824 for an individual and $13,375 for a family. By 2025, those rates had nearly doubled to $9,325 and $26,993, which represented increases of 93% and 102%, respectively. During this same period, inflation increased by roughly 50%, with the consumer price index moving from an average of 214.5 in 2009 to approximately 323 in 2025.