The American health care system presents a familiar puzzle. It absorbs nearly $5T each year, yet ordinary patients rarely know what care will cost, why prices differ so wildly, or who is accountable when costs rise without corresponding improvements in outcomes. Conservatives have long diagnosed the problem correctly. It is not that Americans spend too little on health care. It is that spending is insulated from market discipline, obscured by intermediaries, and structured to protect incumbents rather than patients. President Donald J Trump’s Great Healthcare Plan is best understood as a systematic attempt to reverse those distortions by restoring agency to patients and accountability to providers, insurers, and drug manufacturers.
Begin with prescription drugs. Americans pay more for the same medications than patients in other developed countries. This is not an accident of chemistry or logistics. It is the predictable result of a pricing system in which the largest buyer in the world, the U.S. government, refuses to negotiate as aggressively as smaller foreign systems and allows manufacturers to segment markets to maximize revenue. Trump’s Most-Favored-Nation framework cuts directly through this structure. The principle is simple. Americans should not subsidize lower prices abroad. If a drug company is willing to sell a medication for a given price in Germany or Japan, it can sell it for that price here.
Critics often respond that such an approach risks innovation. But this objection confuses incentives. Innovation depends on expected returns across global markets, not on extracting monopoly rents from one population while offering discounts to another. By anchoring U.S. prices to verified international benchmarks, the Great Healthcare Plan forces manufacturers to compete on efficiency and value rather than political leverage. The experience of Trump’s first-term insulin reforms and the administration’s recent voluntary negotiations confirms the point. Prices fell. Access expanded. Innovation did not collapse.
The plan’s extension of over-the-counter access to verified safe pharmaceuticals reflects the same logic. Many routine medications remain artificially gated behind doctor visits that add cost without commensurate medical benefit. When safety allows, removing those barriers increases competition, lowers prices, and respects patient competence. This is not deregulation for its own sake. It is deregulation targeted at points where regulation has become a substitute for incumbency protection.
Insurance premiums pose a parallel problem. Under the Affordable Care Act, billions of dollars flow to insurance companies through complex subsidy mechanisms that are largely invisible to consumers. These payments are defended as stabilizing markets. In practice, they insulate insurers from competition and weaken incentives to control costs. Trump’s proposal to redirect those funds directly to eligible Americans reverses this flow. Instead of subsidizing institutions, it subsidizes choice.
This shift matters. When individuals control the marginal dollar, insurers must compete for their business. When government directs the marginal dollar, insurers compete for regulatory favor. The Great Healthcare Plan is explicit about this tradeoff and chooses the former. The Congressional Budget Office has already acknowledged that the plan’s cost-sharing reforms alone would save taxpayers at least $36B while reducing the most common Obamacare plan premiums by over 10%. Those savings are not accidental. They arise from aligning incentives with consumer welfare.
Equally important is the plan’s attack on pharmacy benefit managers. PBMs operate in the shadows of the health care system, extracting fees through rebate arrangements that raise list prices while claiming to lower net costs. The effect is to reward opacity. Ending PBM kickbacks does not require heavy-handed price controls. It requires sunlight. When rebates are eliminated and prices must stand on their own, insurers and drug manufacturers must compete openly for consumers.
Accountability is the unifying theme of the Great Healthcare Plan, and nowhere is this clearer than in its Plain English insurance standard. Insurance contracts today are deliberately unreadable. Complexity is not a byproduct. It is a business model. If consumers cannot easily compare plans, denial rates, or profit margins, insurers face little pressure to improve. Requiring insurers to publish coverage comparisons, claims payout percentages, denial rates, and average wait times in plain language forces competition where it has been suppressed.
Some worry that consumers will be overwhelmed by information. But this objection underestimates the adaptive capacity of markets. When standardized disclosures exist, intermediaries emerge to interpret them, and competition shifts toward transparency and service. The same dynamic occurred in financial markets after disclosure reforms. Complexity did not vanish, but accountability increased. The healthcare market deserves the same treatment.
Price transparency completes the picture. Trump’s first-term regulations requiring hospitals and insurers to post prices were a breakthrough. They recognized that no market can function when buyers do not know prices in advance. The failure was not the policy but the enforcement. The Biden administration largely ignored compliance, leaving patients with partial and unusable data. The Great Healthcare Plan corrects this by tying transparency obligations directly to participation in Medicare and Medicaid. If providers want public funds, they must tell patients what care will cost.
This is not punitive. It is reciprocal. Public programs exist to serve patients, not to shield providers from scrutiny. By restoring enforcement and clarifying requirements, the plan gives real meaning to price disclosure. Patients gain leverage. Providers gain incentives to compete on cost and quality. The system gains discipline.
Skeptics often ask whether such reforms are sufficient. Will transparency alone lower costs? Will choice alone discipline markets? The right answer is modest. No single reform can fix a system distorted over decades. But the Great Healthcare Plan does not rely on a single lever. It aligns multiple reforms around a coherent philosophy. Patients should see prices. Patients should control subsidies. Intermediaries should be exposed. Global price discrimination should end.
This philosophy has already guided Trump’s second-term actions. The May 12, 2025, executive order on Most-Favored-Nation pricing produced 16 negotiated agreements with major manufacturers, delivering real relief to millions of Americans. The executive order on health care pricing revived enforcement, strengthened hospital disclosure rules, and proposed meaningful insurance transparency reforms. The Working Families Tax Cuts expanded health savings accounts, reduced fraud, and invested in rural health care infrastructure.
Taken together, these actions reveal the Great Healthcare Plan not as a speculative proposal but as a legislative consolidation of demonstrated successes. Congress is not being asked to leap into the unknown. It is being asked to codify reforms that have already shown results.
The deeper question is philosophical. Should health care be organized around institutions or patients? The American right has long argued for the latter. The Great Healthcare Plan translates that argument into policy with unusual clarity. It rejects centralized price setting in favor of international benchmarking. It replaces hidden subsidies with direct support. It substitutes readable contracts for bureaucratic complexity. It enforces transparency as a condition of public participation.
Congress should pass the Great Healthcare Plan not because it promises perfection but because it restores the moral and economic logic of a functioning market. It treats patients as agents rather than subjects. It treats information as a public good rather than a proprietary advantage. And it treats accountability not as an aspiration but as a requirement.
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Yes needed