For decades, American healthcare has operated around a basic assumption:
The person receiving healthcare is not really the customer.
Employers select health benefits. Insurers determine coverage. Provider networks determine where patients can go. PBMs influence which drugs they receive. And enormous amounts of money move through the system without ever being directly controlled by the person receiving the care.
Chris Ellis, CEO of Thatch, recently published a provocative argument for changing that.
His thesis: give consumers control of the healthcare dollar.
That sounds simple. It could have enormous implications for how healthcare is bought and sold.
From health insurance to a health budget
Most employer-sponsored benefits still follow a familiar structure.
An employer selects a plan or small group of plans. Employees choose among them. The insurer then becomes the financial infrastructure through which most healthcare decisions flow.
Thatch proposes something different.
Instead of primarily giving an employee a health insurance product, the employer gives the employee a healthcare budget. The employee chooses insurance that fits their circumstances, while remaining dollars can be used for other healthcare needs or accumulated for the future.
Ellis calls the accumulated balance "health capital."
The distinction matters.
Traditional consumer-directed healthcare often meant increasing deductibles and asking employees to spend more of their own money. The theory was that financial exposure would turn patients into better shoppers.
In practice, it could also create a powerful incentive to simply avoid spending.
A dedicated health budget changes the equation.
The question becomes less:
"Will my insurance cover this?"
And more:
"What is the best way to spend my healthcare dollars?"
That could create an entirely different healthcare marketplace.
The infrastructure around healthcare would have to change
Giving consumers purchasing power only works if they can actually use it.
Today, shopping for healthcare remains remarkably difficult.
Prices can be difficult to understand. Provider availability is fragmented. Quality is difficult to compare. Insurance rules complicate transactions. Even relatively straightforward services can require navigating multiple disconnected systems.
If consumers increasingly control healthcare dollars, those problems become commercial opportunities.
The winning infrastructure may look less like traditional health-plan administration and more like modern commerce:
Discover → Compare → Choose → Book → Pay
Healthcare has pieces of this already.
Consumers buy certain medications directly. They purchase laboratory testing without going through traditional insurance. They subscribe to direct primary care. They pay for fertility services, behavioral health, dental care, imaging, wearables and preventive health products.
These transactions still sit largely around the edges of traditional healthcare financing.
But the edges are getting interesting.
Healthcare unbundling is accelerating
We have been tracking a broader pattern at Quyra: healthcare purchasing is increasingly being broken into individual components.
Employers are carving services out of traditional benefit structures. Consumers are purchasing certain services directly. Drug manufacturers are experimenting with direct channels. Providers are offering cash prices and memberships. Specialty vendors are building condition-specific care models. And new benefit structures are giving employees more choice over where healthcare dollars ultimately go.
These developments may look unrelated.
They aren't.
They represent different versions of the same structural change:
Healthcare purchasing is becoming more modular.
Instead of one insurance product controlling virtually every healthcare transaction, consumers and employers can increasingly assemble different pieces of healthcare independently.
Insurance still has an essential role—particularly for unpredictable, catastrophic expenses where shopping is unrealistic.
But routine and planned healthcare represents a very different economic problem.
A prescription refill is not an ambulance ride. An MRI scheduled three weeks from now is not emergency surgery. A primary-care visit is not a catastrophic hospitalization.
As healthcare becomes more modular, insurance may increasingly concentrate on what insurance is uniquely good at: pooling unpredictable financial risk.
Everything around it becomes contestable.
The real opportunity is the transaction layer
This creates an important question for healthcare entrepreneurs and investors.
If consumers eventually control substantially more healthcare purchasing power, who helps them decide where to spend it?
Giving someone $10,000 of healthcare purchasing power is useful.
Giving them $10,000 plus transparent prices, provider availability, quality information, navigation, booking and payments is much more powerful.
That suggests a potentially enormous infrastructure layer emerging between healthcare financing and healthcare delivery.
Think of it as the healthcare transaction layer.
It could include price discovery, provider discovery, benefits navigation, quality comparison, scheduling, payments, financing, personalized recommendations, AI-assisted navigation and eventually autonomous healthcare purchasing agents acting within parameters established by consumers.
The companies building these capabilities may become increasingly important if healthcare dollars continue moving closer to the individual.
Follow the dollar
Healthcare business models tend to organize themselves around whoever controls payment.
Historically, that has meant selling to insurers, employers, health systems and other institutions.
A more consumer-directed financing system changes the customer.
And when the customer changes, markets reorganize around them.
That may be the bigger idea behind the health consumer movement.
The transformation isn't simply giving patients better healthcare apps.
It's giving them economic agency.
If meaningful healthcare purchasing power moves toward individuals, the next generation of healthcare companies won't just help people navigate the system.
They'll compete for their business.
And that would represent a much bigger change.
Source: Chris Ellis, "The Health Consumer: A Manifesto," LinkedIn, September 2026.