We don’t have all the answers yet. Here’s why that’s the honest thing to say.
Let’s start with something you almost never hear from a political candidate: we don’t have a comprehensive healthcare plan yet. That’s not because we haven’t been thinking about it—it’s because anyone who tells you they have a simple fix for American healthcare is either lying to you or doesn’t understand the problem.
What we do know is that the system is broken in ways that affect every single American. Insurance premiums have been rising faster than wages for decades—the CMS National Health Expenditure data shows healthcare spending now consumes nearly 20% of GDP. Pharmaceutical costs are wildly inflated compared to every other developed country—HHS research confirms that Americans pay multiples of what other nations pay for the same drugs. Pharmacy Benefit Managers—middlemen that most Americans have never heard of—are extracting billions from the system while adding no value to patient care. Co-pays, deductibles, and out-of-pocket maximums have gotten so high that having insurance sometimes barely feels like having insurance at all.
Both parties have taken their shots at fixing this. The ACA expanded coverage, which mattered, but it didn’t solve the underlying cost problem. Republican attempts to repeal and replace never produced a viable alternative. Dozens of reform proposals have come and gone—price transparency rules, PBM regulation, drug importation, public options, Medicare expansion—and costs keep climbing. The system is so tangled, with so many players extracting money at every level, that incremental reforms keep getting swallowed by the complexity.
Here’s something that might surprise you: Seth’s family hasn’t had health insurance for three years. They ran the numbers, made the decision to drop coverage, and started paying cash for everything—doctor visits, prescriptions, imaging, lab work. Every single year, they’ve come out significantly ahead compared to what premiums alone would have cost, before you even factor in co-pays and out-of-pocket expenses.
They were fortunate enough to have the financial cushion to take that gamble. Most families don’t feel like they can. But the fact that going without insurance entirely is the financially smart move for anyone who can afford the risk tells you everything you need to know about how broken the system is.
And it’s not as though insurance was working well when they had it, either. In 2014, his wife, Nicole, was diagnosed with Lyme disease. Even though the family was fully insured at the time, basically everything that seemed to actually work in her fight against it wasn’t covered—for one reason or another, treatment after treatment was denied or excluded. They were paying premiums every month for coverage that, when they needed it most, didn’t cover the things that were actually helping.
When having no insurance is cheaper than having insurance—and even when you do have it, it doesn’t cover the treatments that actually work—something has gone fundamentally wrong. That’s not a market functioning properly. That’s a system that has lost sight of its purpose.
We may not have the full plan yet, but we know a few things with certainty:
The status quo is unacceptable. Healthcare costs are the number one cause of personal bankruptcy in America. Families are rationing insulin, skipping preventive care, and choosing between prescriptions and groceries. This is the wealthiest country in the history of the world. There is no excuse for this.
Neither party has solved it. Democrats expanded access but haven’t controlled costs. Republicans have opposed nearly every reform without offering a workable alternative. Both sides are more interested in using healthcare as a political weapon than actually fixing it. The industry’s lobbying spend—more than any other sector—ensures that any reform with teeth gets watered down before it reaches a vote.
The system’s complexity is the enemy. Healthcare in America isn’t one problem—it’s a dozen interconnected problems. Insurance companies, hospitals, pharmaceutical manufacturers, PBMs, device makers, malpractice law, employer-sponsored coverage, Medicare, Medicaid—they’re all woven together in ways that make any single fix feel like pulling one thread from a sweater. Change one thing and three other things break.
Transparency is a prerequisite. Before we can fix the system, Americans need to be able to see how it actually works. Where does the money go? Why does the same procedure cost $800 at one hospital and $8,000 at another across town? Why do PBMs negotiate rebates that never reach patients? Why can the same drug cost ten times more in America than in Canada? Transparency won’t solve everything, but you can’t fix what you can’t see.
We’re not going to pretend we have it all figured out. The honest truth is that healthcare reform at the scale America needs is one of the most complex policy challenges in the world. Anyone who claims to have a tidy answer either hasn’t done the reading or is selling you something.
Here’s what we’re still working through:
What’s the right model? Single-payer? Multi-payer? A hybrid system? Each has trade-offs. Countries that have universal coverage generally achieve it through very different mechanisms, and none of their systems would transplant cleanly into a country of 330 million people with the existing infrastructure we have. We’re studying what works, what doesn’t, and what might actually be achievable in the American context.
How do you untangle the existing system without breaking it? Roughly 160 million Americans get their insurance through their employer. You can’t just blow that up overnight without creating chaos. Any transition has to be gradual, carefully managed, and designed to avoid leaving people worse off during the change.
How do you control costs without killing innovation? American pharmaceutical and medical device companies produce more innovation than anywhere else in the world, in part because the American market pays higher prices that fund R&D. There’s a legitimate tension between bringing costs down and maintaining the incentive structure that drives medical breakthroughs. We need to find the balance, not pretend the trade-off doesn’t exist.
We just said we won't pretend to have a tidy fix for the whole system—and we don't. But honesty cuts both ways, and there's one corner of American health care where the answer really isn't a mystery: what we pay for prescription drugs. Americans pay, on average, about 2.8 times what people in other wealthy nations pay for the exact same medicines—and for brand-name drugs, more than four times as much. Same pill, same factory, multiples of the price—just because it's sold to an American.
And we now have proof that fixing it works. After years of being barred from even negotiating, Medicare began bargaining over its costliest drugs, and the first negotiated prices took effect in 2026—cuts ranging from 38% to 79% on some of the most widely used medications, saving billions. Medicare's $35-a-month cap on insulin is already sparing seniors from rationing a drug they need to live. These aren't theories. They happened.
So here's a place we can be concrete: let Medicare keep negotiating and widen the list; extend the $35 insulin cap to every American, not just seniors; rein in the pharmacy-benefit middlemen who pocket the spread between what they charge and what they pay; and open the door to safe importation and faster generic and biosimilar competition. No American should be splitting pills or skipping doses because the same medicine that's affordable across the border costs a fortune here. We may not have every answer on health care—but on this one, we do.
Every election cycle, candidates promise to “fix healthcare.” They wave around bullet-point plans and 30-second sound bites. And nothing changes—because the problem is harder than any campaign speech can capture, and the political incentives reward promising solutions over delivering them.
We’re taking a different approach. We’re going to be honest about what we know, honest about what we don’t know, and committed to doing the hard work of actually understanding this problem deeply enough to propose solutions that might work—not just solutions that sound good in a debate.
That means talking to doctors, nurses, hospital administrators, insurance executives, pharmacists, patients, economists, and anyone else who lives inside this system every day. It means studying what other countries have done right and wrong. It means being willing to say “I was wrong” when the evidence points in a different direction than we expected.
If you work in healthcare and have ideas, we want to hear from you. This is too important and too complex to figure out in a back room. The best solutions are going to come from the people closest to the problem.