The Make America Healthy Again movement challenges our nation to recognize that health insurance, health care, and health are fundamentally distinct. Past health policy reforms, largely focused on health insurance, have neither improved health care nor made Americans healthier. To make America healthy again, we must restore health insurance to its original purpose. Insurance exists to protect beneficiaries from unexpected financial risks. It is not intended to cover routine, predictable or elective events, as this would make premiums prohibitively expensive. For example, were a car insurance policy that to cover oil changes, or were a home insurance policy to cover faucet repairs, they would be priced out of the market. But when it comes to health, regulations are forcing insurers to cover analogously uninsurable items. Many politicians aim to expand health coverage to all health care products and services — even air conditioning — while minimizing patients’ out-of-pocket costs. This approach deprives patients of decision-making power and providers of autonomy. Consequently, competition and innovation have stagnated, prices and premiums have risen, and health outcomes have worsened. Industries lobby aggressively because regulators, not patients, make decisions that affect industry profits. Even without intentional capture, regulations are typically regressive, favoring incumbents that can afford compliance costs. This leads to more regulations, greater consolidation, higher prices, fewer choices and worse access. Health insurance should return to its original purpose: protection against major unpredictable financial risks, such as motor vehicle accidents, strokes and heart attacks. Primary care, generic drugs, routine care and elective surgeries — which make up the majority of health care spending — should be paid for in cash using pretax funds from health savings accounts or HSAs. This reform would slash premiums while relieving patients of financial worry. All Americans should have access to HSAs, which allow individuals and private entities to contribute, with tax benefits. To protect low-income, high-risk individuals, taxpayers should fund reinsurance programs to stabilize their premiums and directly subsidize their HSAs. When cash is the primary form of payment for care, and insurance is reserved for covering significant financial risks, transformative changes would follow.  First, patients controlling their health care dollars would no longer face insurance restrictions on provider options, gain equal access to care at non-discriminatory cash prices, and make informed, cost-conscious decisions that reflect their specific preferences. With more skin in the game, they would also be motivated to invest in preventive efforts to fundamentally improve their health. Second, when paying for care becomes as straightforward as buying coffee, entry barriers would collapse, regulatory capture would diminish, price competition would intensify, and innovative care options would flourish to meet patients’ diverse and evolving needs. A dynamic, accessible, and personalized ecosystem for patient-centered care would emerge.    Third, providers would be freed from pre-authorizations, denials, appeals and other restrictions and burdens that have led to financial loss, burnout and missed opportunities to deliver optimal care. Physicians across specialties have increasingly opted out of certain insurance plans. This trend would reverse under the proposed system, expanding access to all patients regardless of their insurance status. Finally, the labor market and economy would benefit. When workers control their health care dollars, purchase insurance locally, and pay for other health care needs through HSAs, employers are relieved of the burden of purchasing insurance. This shift would enhance worker mobility, simplify hiring and spur innovation and entrepreneurship. Flat-rate direct primary care, concierge practices, cash-pay surgical care, telehealth and prescription drugs are already flourishing. These models adopt transparent and competitive pricing, attracting both uninsured patients and those who bypass their insurance. Top-down regulatory restrictions cannot suppress the bottom-up demand from patients and providers to transact directly, without intermediaries. The Make America Healthy Again movement opens an opportunity window toward a dynamic, innovative, accessible U.S. health care ecosystem. We can either maintain the status quo — which constrains providers from competing fairly and freely for patients, insurers from offering plans patients want, and patients from accessing the care they want to be healthy — or unshackle all of them by restoring health insurance to its true nature: being insurance. Josh Puthumana is a surgical resident at the Johns Hopkins School of Medicine. Ge Bai is a professor of accounting and health policy at Johns Hopkins University.