Health Care Reforms Part 9: The Right Price of Healing - A MAGA Health Care Reform Plan and Making U.S. Healthy and Great Again

The enhanced healthcare subsidies under the Affordable Care Act (ACA) — which have kept insurance premiums affordable for millions — are set to expire at the end of 2025 unless Congress takes action. The ruling republican government has so far not introduced a clear or comprehensive plan to extend these subsidies or to significantly reduce healthcare costs nationwide. While public support for continuing the subsidies remains high, legislative progress has stalled. Without renewal, millions may face steep premium hikes or lose coverage entirely, especially older and rural Americans. The least, the ruling Trump administration can do is to continue the health care subsidies under ACA when it doesn’t have a clear alternative. There is no plan to substitute ACA and the government is not willing to extend these benefits either. The result is the longest shut down in the American history. The biggest lesson and the takeaway is Trump admin should come up with a practical plan to lower health care costs across America and make the nation healthy again. This is the basic prerequisite for making the nation great. Unless this is taken care, the government may continue to lose elections as happened over the last week. In this post, let us dissect the draconian health care situation of American and propose a clear blueprint to make the country healthy and great again. It has already been one year since the Trump admin won elections in second term and this is high time a comprehensive plan of action is formulated to tackle the problem head-on in the short and long term. This will be the judicious use of tremendous executive power and acceptance the POTUS enjoys after more than 10 years in public service at the highest level. Democracy survives when there are democratically accepted solutions and not through evasive maneuvers escaping responsibility without any plan in place. Else it will be an amateur king holding highest office with ‘No Kings’ protests ruling the roost. Let us flip it in the next three years when it matters the most. 

America spends $4.3 trillion annually on healthcare—$12,900 per person—yet ranks below Costa Rica in life expectancy and behind Slovenia in infant mortality. We spend twice what Germany spends, 2.5 times what Britain spends, and three times what South Korea spends per capita, while achieving outcomes that would embarrass a developing nation. A routine appendectomy costs $3,000 in Britain and $33,000 in America. An MRI runs $138 in Australia and $1,420 here. Insulin that costs $6 in France carries a $300 price tag in Florida. This isn't healthcare—it's wealth extraction masquerading as medicine. 

Making America great again requires making America healthy again. The path forward isn't mysterious—dozens of nations have solved problems America treats as unsolvable. What's required is honesty: the willingness to name what's broken, identify who profits from the brokenness, and implement solutions that work everywhere else they've been tried. 

What Drives the Cost Crisis 

Administrative Bloat: The $1 Trillion Paperwork Tax 

American healthcare employs more billing specialists than nurses. For every physician, there are nearly ten administrative staff processing claims and managing bureaucracy. Administrative costs consume 34% of healthcare spending—roughly $1.1 trillion annually. Canada spends 17% on administration. Taiwan spends 2%. The difference? America has 900+ insurance companies, each with unique billing codes and approval processes. Physicians spend 16% of their time on paperwork instead of patients. This isn't healthcare—it's an employment program for bureaucrats funded by sick people. 

Pharmaceutical Pricing: Legalized Extortion 

America is the only developed nation prohibiting government from negotiating drug prices. Pharmaceutical companies charge whatever the market will bear when the alternative is death. Insulin costs $6-12 to manufacture and sells for $300-400 in the U.S. The same vial costs $30-40 in Canada, produced by the same companies. Cancer drugs cost 2-10 times more in America than Europe. The pharmaceutical industry spent $374 million on lobbying in 2021 to maintain this pricing power. Americans subsidize drug development for the entire world while Europeans pay reasonable prices for identical medications. 

Hospital Monopolies and Insurance Middlemen 

Healthcare consolidation has created regional monopolies where 1-2 hospital systems control entire markets and set prices unilaterally. Hospitals charge $100 for saline bags costing $1. Emergency rooms charge "facility fees" of $1,000-3,000 simply for walking through the door. The top seven health systems generated $35 billion in profits in 2022 while claiming nonprofit status. 

Health insurance companies employ 500,000+ people whose primary function is denying claims. They add zero clinical value—they simply stand between patients and care, extracting profit. The top six insurers generated $60 billion in profits in 2022. Meanwhile, 30 million Americans remain uninsured, and 100 million struggle with medical debt. 

Fee-for-Service and Price Opacity 

American physicians are paid per procedure, not per outcome, creating perverse incentives for overtreatment. Studies suggest 20-30% of healthcare spending provides zero clinical benefit. Americans receive twice as many MRIs per capita as Germans, not because Americans are sicker, but because MRIs generate revenue. 

Try learning the cost of a procedure beforehand—you'll fail. Hospitals don't publish prices; physicians often don't know them. Patients make healthcare decisions without basic information governing every other purchase. This prevents price competition by design. That's American healthcare. 

How Other Nations Solved What America Won't 

Germany maintains private insurance but regulates it strictly. All insurers must offer identical base coverage at government-set prices, cannot deny coverage for pre-existing conditions, and face profit margins capped at 3-5%. Drug prices are negotiated nationally. Result: Universal coverage, excellent outcomes, $6,700 per capita—half of America's costs. 

Taiwan implemented single-payer in 1995 covering 99.9% of the population. Administrative costs: 2% versus America's 34%. Every citizen carries a smart card containing complete medical history. No prior authorization, no claim denials, no billing departments. Taiwan spends $3,000 per capita achieving health outcomes exceeding America's. 

Singapore requires citizens to save 8-10% of income in personal health savings accounts for routine care, while government provides catastrophic insurance. Mandatory price transparency forces competition. Result: $3,500 per capita—lowest among developed nations—with outcomes matching America's. No medical bankruptcies, universal coverage, costs one-quarter of ours. 

France consistently ranks #1 globally in healthcare performance. Universal coverage through statutory health insurance with private supplemental options. Physicians are private practitioners paid fee-for-service at regulated rates. Drug prices are negotiated nationally. Result: Better outcomes than America at $5,500 per capita—less than half U.S. spending. French patients see physicians same-day, face no medical debt, and live three years longer than Americans. 

The MAGA Healthcare Plan: Making America Healthy Again 

Phase One: Immediate Cost Reduction (Year 1) 

Medicare drug price negotiation for all. Extend Medicare's negotiating power to all payers. If Medicare negotiates insulin to $35, everyone pays $35. Pharmaceutical companies can sell in America at negotiated prices or not at all. This isn't price controls—it's monopsony purchasing power that every other nation exercises. Estimated savings: $150-200 billion annually. 

Mandatory price transparency with teeth. Require hospitals, physicians, and insurers to publish all prices in machine-readable formats. Violations carry penalties of $10,000 per day per undisclosed price. Enable comparison shopping through government-run website aggregating all provider prices. This alone could reduce costs 20-30% through actual market competition. 

Eliminate surprise billing permanently. Federal law prohibiting balance billing for any out-of-network care the patient didn't explicitly choose. No more $100,000 bills because the anesthesiologist wasn't in-network. Payment disputes get resolved between providers and insurers—patients are held harmless. 

Cap administrative costs at 10%. Require insurance companies to spend 90% of premiums on actual healthcare. Excess profits must be rebated to policyholders. Estimated savings: $40-60 billion annually redirected from insurance profits to patient care. 

Phase Two: Structural Reform (Years 2-3) 

Public Option on Exchange. Offer Medicare buy-in for anyone under 65 at actuarially fair rates. This isn't Medicare for All—it's Medicare as option, competing with private insurance. The public option's administrative efficiency (2-3% versus 15-20% for private insurance) forces private insurers to compete on efficiency rather than claim denial. Estimated coverage expansion: 15-20 million people. Cost reduction: $100-150 billion annually. 

All-payer rate setting for hospitals. State or regional commissions set hospital prices for all payers. Maryland has used this system for 50 years with costs 30% below national average and superior outcomes. Hospitals receive fair compensation but cannot exploit market power. 

Primary care investment. Redirect $50 billion annually to primary care through enhanced payment for prevention and care coordination. Prevention is dramatically cheaper than treatment. Incentivize medical students into primary care through loan forgiveness: four years of service in underserved areas eliminates medical school debt. 

Break hospital monopolies. Aggressive antitrust enforcement blocking hospital mergers in concentrated markets. Require divestitures where single systems control over 50% of market share. Monopoly power is the enemy of affordable healthcare—restore competition. 

Phase Three: Fundamental Transformation (Years 4-10) 

Capitated payment models. Transition from fee-for-service to population health management. Insurers or provider groups receive fixed amounts per patient annually, covering all care. They profit by keeping people healthy, not by maximizing procedures. This is how Kaiser Permanente operates and why Kaiser costs 20-30% less with equal or better outcomes. 

Medical education reform. Federal funding for medical schools contingent on eliminating tuition. Train physicians debt-free like Germany, France, and Scandinavia. Estimated cost: $5-7 billion annually. Savings from increased primary care supply and reduced physician salary requirements: $30-50 billion annually. 

Prescription drug manufacturing. Establish federal generic drug manufacturing for essential medications where private sector creates shortages or excessive pricing. California has begun this with insulin; scale nationally. Market competition from public manufacturer forces private companies to price rationally. 

Comprehensive catastrophic coverage. Above $5,000 annual out-of-pocket, federal coverage kicks in for everyone regardless of insurance status. Medical bankruptcy becomes impossible. Estimated cost: $80-100 billion annually. Savings from eliminating bankruptcy costs and uncompensated care: comparable or greater. 

Why This Could Actually Happen 

Healthcare costs crush businesses and governments across the political spectrum. Small business owners cite healthcare costs as their number one concern. Both left and right populism share healthcare as common enemy. Progressive populists attack pharmaceutical companies and insurance profiteers; right populists attack government waste and regulatory capture. 

Medicare and Medicaid consume 25% of federal spending and grow 6-8% annually—faster than GDP or revenues. This trajectory leads to fiscal crisis within a decade. Solving healthcare isn't optional—it's mandatory for fiscal sustainability. Trump's unique political position enables him to attack healthcare profiteers while maintaining base support. His base supports Medicare drug negotiation, price transparency, and surprise billing elimination at 60-70% rates. 

The Practical Implementation 

Executive Action (Day One): Issue orders requiring price transparency enforcement, directing HHS to implement Medicare drug negotiation for maximum medications, and establishing task force to identify anti-competitive hospital behavior. These require zero congressional approval. 

Legislative Package (First 100 Days): Introduce comprehensive healthcare bill as "Healthcare Freedom Act"—freedom from medical bankruptcy, surprise bills, and price gouging. Those opposing must explain to constituents why they're protecting insurance company profits over patient welfare. 

State partnerships: Offer federal waivers and matching funds for states implementing all-payer rate setting or single-payer systems. Let states compete to demonstrate best models. Federalism as laboratory of democracy. 

Regulatory enforcement: Direct FTC, DOJ, and HHS to aggressively enforce existing antitrust law in healthcare markets. Block anti-competitive mergers and penalize price-fixing. Current law prohibits monopolistic behavior—enforce it. 

The Vision: America in 2030 

A family of four in Ohio pays $400 monthly for comprehensive coverage through the public option—less than half their current premium. When their daughter breaks her arm, they pay $100. No surprise bills, no medical debt. Total annual cost: $7,900 for complete healthcare. They save $8,000 compared to 2024. 

A small business owner in Texas expands from 12 to 25 employees, offering healthcare at $300 per employee monthly—half what large corporations pay. A retiree in Florida takes prescribed medications for $40 monthly, down from $450, thanks to Medicare drug negotiation. A young physician in Montana graduates debt-free and opens a primary care practice in an underserved rural community. 

America's life expectancy increases for five consecutive years, rising from 77 to 80. Infant mortality drops 20%. Maternal mortality drops 30%. Federal healthcare spending stabilizes at 10-12% of GDP, down from 18%. The $1.5-2 trillion in annual savings funds infrastructure, education, deficit reduction, and tax cuts. 

This isn't fantasy. This is achievable, proven reality in dozens of nations. 

The Bottom Line: Greatness Through Health 

Making America great again requires making Americans healthy again. A nation where 100 million people struggle with medical debt isn't great—it's failing its citizens. Healthcare is central to national greatness. Healthy citizens work more productively. Children who receive preventive care become educated adults. Businesses unburdened by healthcare costs invest in innovation and wages. 

The solutions exist. The evidence is overwhelming. What remains is leadership willing to name the disease and prescribe the cure. Other nations prove both quality and affordability are achievable simultaneously. Fundamental transformation isn't radical—it's necessary. America can do this. The question is whether we have the courage to try, the wisdom to learn, and the determination to succeed. Until we solve healthcare, we're not making America great—we're just making healthcare executives rich while Americans die preventable deaths. The choice is clear. The path is proven. The moment is now. It is high time a plan of action is scheduled, a time frame for action is in place, and change on the ground is rolling towards making America healthy and great, again.