After more than a decade dealing with the so-called Affordable Care Act (aka “Obamacare”), Americans are still struggling with rising health care costs.

Overall health care costs continue to climb–and employers, families, and taxpayers are all paying more. Health care has, in fact, become less affordable for families. Insurance premiums are skyrocketing. Meanwhile, patients’ choices are shrinking, and access to care hasn’t improved.

Obamacare has failed to deliver on its promises.

Yet, many politicians are calling to double down on Obamacare, increasing subsidies to insurance companies and making more individuals dependent on government programs. Many politicians and special-interest groups want to extend temporary “emergency” premium subsidies passed during the COVID-19 pandemic.

This would be a colossal mistake.

These insurance company subsidies cap what families pay, but not taxpayers’ liability. That encourages insurers to raise premiums, knowing higher prices mean larger subsidies. The result is more spending with no improvement in affordability.

The subsidies also encourage waste and fraud. Many enrollees are double-covered or never use their plans. In some states, a significant share of subsidized enrollees had no claims, suggesting “phantom coverage.” At the same time, Obamacare subsidies discourage employer-provided coverage, driving up costs for the tens of millions of families who rely on it.

The problem is not a lack of subsidies. The problem is a system built around the wrong incentives.

Obamacare centralized decision-making in Washington, D.C., imposed one-size-fits-all mandates, and sent billions of taxpayer dollars to insurance companies instead of patients. The law limits competition, restricts plan design, and shields insurers from price pressure. It is no surprise that costs have continued to rise year after year.

Rather than pouring more taxpayer money into a broken system, we should focus on reforms that lower costs by empowering patients and increasing competition.

Genuine health care reform starts with a simple principle: subsidize individuals, not insurance companies. Health care dollars should follow the patient and give families control over how to spend their money.

One solution is expanding tax-free health savings accounts (HSAs) into “large HSAs” or “health freedom accounts.” These accounts, which cover more than traditional HSAs, would allow individuals and families to save and spend their own health care dollars on insurance, doctor visits, prescriptions, and other medical expenses. Instead of subsidizing insurance companies, Obamacare subsidies should go to individual health care accounts. Employers should also be able to contribute to any employee’s account.

Because patients would control the money, they have incentives to seek value, ask questions, and shop for better options. That pressure helps drive costs down.

We should expand the services covered by these accounts, including direct primary care, where patients pay a monthly fee for direct access to a family doctor. This restores doctor-patient relationships, improves access, and often costs less than traditional insurance-based primary care.

Further, Americans should be able to shop for health insurance nationwide, not be limited by state lines. Lower-cost catastrophic plans should be widely available, especially for younger, healthier individuals seeking protection against major medical expenses. Small businesses, gig workers, and the self-employed deserve access to affordable coverage options that large employers already enjoy through association health plans.

Access to care also depends on supply. We need more doctors, nurses, and health care providers, especially in rural and underserved areas. That means allowing health professionals to practice to the full extent of their training and removing unnecessary barriers that limit competition. More providers mean shorter wait times, greater access, and lower costs.

Price transparency must become the norm in health care. Patients should know the price of care before receiving it. Clear pricing and fewer surprise bills empower consumers and force providers to compete in value, just as they do in every other sector of the economy.

Thus far, lawmakers have proposed more of the same that got us into this mess in the first place: enacting new taxes, eliminating private insurance, or expanding government-run health care.

Rather than taxpayer subsidies propping up a failing system, we should pursue reforms that actually make health care more affordable.

Genuine reform begins with restoring patient choice, affordability, and accountability to a system that has drifted away from all three. Families and patients, not politicians and bureaucrats, should decide about their coverage and care.

That is how we make health care work again.

Nathan Benefield is the chief policy officer of the Commonwealth Foundation.