Every new year brings another round of promises to “fix” American healthcare. Too often, the solutions look familiar: reduce access, narrow networks, push more cost onto consumers, or squeeze providers a little harder. That’s not cost reform. That’s rationing by another name. If we’re serious about bending the cost curve without hurting patients or burning out the workforce, we need to start with the most obvious place: administrative waste.

Administrative spending now consumes roughly one-third of US healthcare expenditures, with the majority tied to billing, revenue cycle operations, contracting, pricing complexity, documentation mandates, and compliance layers that compound upon one another. The United States spends more on managing its health system than entire developed nations spend providing care. 

This complexity is not accidental. It comes from fragmented benefits, conflicting payer policies, duplicative regulations, and technology built for compliance rather than usability and interoperability. The result is a marketplace with hundreds of thousands of plan variations, hundreds of thousands of billable services, and tens of billions of negotiated prices, each requiring verification, validation, adjudication, appeals, auditing, and documentation. Complexity itself has become a cost center.

And the impact isn’t abstract. It sits directly on the workforce.

Physicians now spend up to 17% of their working time on administrative work that does not advance clinical care. Prior authorization burdens, duplicative reporting, inconsistent billing rules, and siloed EHR requirements erode productivity, accelerate burnout, and drain capacity from a workforce already facing projected shortages. And this doesn’t even include the cottage industry of staff practices must employ just to navigate every payer’s rules before a patient can be seen and a claim paid.

Administrative inefficiency has become a clinical access problem. And a costly one at that.

Real reform requires discipline, not just shifting burden from one stakeholder to another. It begins with requirements to simplify the operating rules of the system itself. That means standardizing core billing transactions, eligibility processes, and benefit designs where variation adds unnecessary complexity without additional clinical or consumer value. Including placing rational, enforceable limits on prior authorization. Preserving the need where there is clear, evidence-based justification, but ending its use as a broad cost-containment tactic. 

The same expectation must apply to payment innovation. Value-based care must be tied to measurably healthier outcomes, not heavier paperwork. If a model requires experts to interpret and a team just to stay compliant, it’s not reform. Rather, it’s administrative inflation dressed up as innovation.

Targeting administrative waste isn’t symbolic reform. It is a practical policy direction that lowers spending without cutting care and frees up workforce capacity immediately. Clinical experience will be improved by allowing providers to focus on patients rather than paperwork.

As we ring in the new year, we have an opportunity to reset our priorities. It’s time to simplify. Stop designing workarounds for complexity. Start dismantling it. Reducing administrative waste is one of the clearest ways to lower costs while improving care. The United States has world-class clinicians and unmatched innovation. It should not require a parallel economy of bureaucracy just to function.