Rising healthcare costs are once again a top concern for voters in the 2024 election. While members of both parties agree that costs are too high and have discussed these challenges during the presidential and vice presidential debates, the candidates have not been specific about their plans to address them.
Former president Trump was widely challenged for saying he had “concepts of a plan” to fix healthcare. That said, neither Trump nor Vice President Harris has outlined detailed proposals to address the fundamental challenges of this nation’s healthcare that will require systemic reform. Despite different political approaches, both candidates’ policies focus on symptoms of the healthcare crisis, like drug pricing and insurance coverage, without addressing the broken business model of healthcare.
The healthcare system is failing not only because we invest heavily in it without receiving commensurate value in return, but because the entire structure—how care is delivered, paid for, and incentivized—is unsustainable.
The Harris-Walz proposal looks to expand government safety nets and institute new regulation that is likely to further distort market dynamics. Harris is seeking to build upon Biden-era legislation like the American Rescue Plan Act and the Inflation Reduction Act, which extend ACA eligibility and subsidies through 2025. She also wants more price controls on pharmaceuticals. As I wrote about in a recent column, Vice President Harris aims to expand key provisions of the Inflation Reduction Act beyond Medicare recipients. Her plan would extend the $35 monthly insulin cap and the $2,000 annual limit on out-of-pocket prescription drug costs, currently available to seniors, to all Americans.
The Trump-Vance ticket, while taking steps toward market-based reforms like price transparency, ultimately falls short of addressing the deeper, structural issues within healthcare—offering, like their opponents, only band-aid solutions to a system in need of more fundamental change. During his first term in office, president Trump introduced price transparency requirements for healthcare providers, which sought to make healthcare pricing more accessible and understandable to consumers. The healthcare delivery segment successfully resisted these efforts even after the Supreme Court decision enforcing the law. J.D. Vance highlighted the importance of this issue during the Vice Presidential debate, saying that in healthcare, “price transparency will actually give American consumers a little bit more choice, and will also drive down costs.”
As president, Trump tried to implement price controls, proposing to cap drug prices based on lower prices paid in other countries, called the Most Favored Nation model. Although the plan was ultimately rejected in court, Trump’s campaign has not taken a definitive stance on how he would address drug prices if elected to a second term. The price of pharmaceuticals seems to remain a bipartisan concern, and as I have written elsewhere will need an integrated set of solutions, not recurring band-aids aimed at one segment of the market.
Ultimately, piecemeal solutions from both parties will not deliver what the patient-consumer needs: better health outcomes at lower total cost of care. Neither party is looking with a wide enough lens. As such the solutions being proposed fail to address root causes.
The fundamental problems of healthcare won’t be addressed at the margins—essentially tweaking one regulation at a time without understanding how the component pieces fit together. CMS has been trying to bend the cost curve unsuccessfully for over 30 years; prices have continued to rise while outcomes have faltered, and satisfaction has declined. More integrated solutions—ones that address concerns from across the political spectrum—remain unexplored, which leaves us with short-term fixes that have added complexity and cost to an overly complex, costly and opaque system.
As I’ve outlined elsewhere, politicians from both sides of the aisle should focus on underlying total healthcare costs, including the cost of regulation, transparency, and quality outcomes rather than narrowly fixating on the cost of prescription drug prices or insurance coverage in a vacuum. Both are symptoms of the broader issue—a healthcare model that is fundamentally broken with misaligned incentives. Piecemeal solutions serve as a distraction from solving the underlying problem.
In the current system, healthcare delivery, payers (traditional insurers, employers, and the government), pharma, medical device companies and consumers—each component of the industry—are not incentivized to consider, much less embrace, an innovative market-based model, in which payment is connected to outcomes that matter. But this is the model that consumers need. If the next administration is committed to reforming the healthcare industry for the better, it must realign incentives through cost and quality transparency, accountability for care delivery across the continuum, and policies that encourage competition for consumers/employers based on outcomes that matter.
Price transparency, which Trump and Vance have embraced, and Harris and Walz should support, is what enables patient-consumers to make informed decisions about their healthcare, just as they do in other parts of their lives. We expect to compare our options when we buy a new computer or sign up for a fitness class. We ask if the product or service we are buying is worth the cost compared to its competitors. Going forward, innovative organizations need to build compelling data-based value narratives describing their services and answer the question, ‘Why should I go to ‘x’ for my healthcare services?’
If the goal is to make American healthcare more accessible and affordable, the next Presidential ticket must implement a market-based model of reform: transparency, accountability, and competition to produce outcomes that matter.
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