{"id":722,"date":"2026-08-27T09:38:14","date_gmt":"2026-08-27T09:38:14","guid":{"rendered":"https:\/\/frontierhousingreport.com\/?p=722"},"modified":"2026-08-27T09:38:14","modified_gmt":"2026-08-27T09:38:14","slug":"health-care-reform-needs-more-than-universal-coverage","status":"publish","type":"post","link":"https:\/\/frontierhousingreport.com\/?p=722","title":{"rendered":"Health Care Reform Needs More Than Universal Coverage"},"content":{"rendered":"
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The Trump administration is desperate for good news on inflation, so when they saw that prescription drug prices had dropped by the largest amount in 60 years, they grabbed onto that for dear life. \u201cNo previous Administration achieved this,\u201d the White House boasted in a press release, congratulating themselves for \u201cdelivering real relief to American families and putting patients first.\u201d<\/p>\n

Read more Are the College Democrats a Bellwether for 2028?<\/a><\/p>\n

It seems reasonably clear that the administration that delivered this was, in fact, the \u201cprevious Administration,\u201d namely, Joe Biden\u2019s. The lion\u2019s share of the drop is attributable to drug price negotiations in Medicare, which just kicked in this year for ten high-priced medications. Some of the negotiated prices are 79 percent below the previous level. That Democrats put together a health care intervention designed not to lower prices until the next<\/em> president\u2019s term is severe political malpractice, but it happens to be the truth.<\/p>\n

More from David Dayen<\/em><\/strong><\/p>\n

Trump\u2019s innovation, the TrumpRx \u201cdiscount\u201d program, offers the same deals available on direct-to-consumer drug company websites and only assists people who don\u2019t already have a prescription drug plan, while helping to maintain stubbornly high list prices. His \u201cmost favored nation\u201d deals, which were touted in the press release, haven\u2019t even been implemented. By ending subsidies for Medicare Part D premiums, drug costs for seniors are likely to go up even if drug prices go down. \u201cNone of the PR stunts that Trump has pulled on drug prices are actual serious policy,\u201d said drug policy expert Alex Lawson of Social Security Works.<\/p>\n

The Consumer Price Index for medications is a real black box that doesn\u2019t equal out-of-pocket costs and doesn\u2019t count expensive specialty drugs. But even if you take it at face value, the bigger story is that, regardless of who should take credit, the greatest prescription drug price drop in 60 years is only a reduction of 3.1 percent, and that\u2019s a crude average; we know that over 270 drugs went up in price this year. When the White House says that TrumpRx has saved customers more than $700 million in the first six months as if that\u2019s a meaningful number, they leave out that annual prescription drug spending is likely to top $1 trillion this year.<\/p>\n

Americans were paying nearly three times as much for their prescriptions as patients in other countries in 2024, and a minuscule decrease isn\u2019t going to meaningfully change that.<\/p>\n

The larger point is that the structure of the American health care system is driving the higher costs, worse outcomes, and medical worker misery. Adding new structures that replicate the old, cover only portions of the system, or fail to strike at the heart of the matter will inevitably fail, and a stressed public will look at the war to take credit for a meaningless improvement they don\u2019t feel and wonder what planet Washington policymakers are from.<\/p>\n

A new from the American Economic Liberties Project, shared exclusively with the Prospect<\/em>, actually undertakes the task of transforming the health care system, and while it\u2019s complementary to a Medicare for All approach, single-payer insurance is not mentioned. The paper is called \u201cBreak Up Big Medicine,\u201d and it identifies the drivers of American health care dysfunction as corporate infiltration, relentless consolidation, vertical integration, and an endless series of middlemen and new methods for extracting public money.<\/p>\n

In effect, the public pays twice: first through higher premiums and out-of-pocket costs, and then through higher government payouts to corporate health care companies. The United States spends the equivalent of $15,000 per year for every man, woman, and child on health care; this is around 20 percent of the economy and more than twice the level of other industrialized countries.<\/p>\n

The report is critical at a time when Medicaid cuts and the expiration of Affordable Care Act subsidies engineered by the Trump administration are significantly boosting the uninsured population and the burden on hospitals to deliver uncompensated care. The belief perpetuated by rising costs that America can\u2019t afford to provide its citizens with medical care is incorrect, advocates argue: Solutions outlined in the report are estimated to save not $700 million, but $795 billion<\/em> annually, primarily by reducing administrative bloat and corporate profit-taking.<\/p>\n

\u201cIn tandem with moving toward a Medicare for All system, we have to address consolidation that is the cause of health care being so expensive, with degraded quality, and the squeezing of health care professionals,\u201d said Emma Freer, one of the co-authors of the report. \u201cOtherwise we end up with something like Medicare Advantage for All, which would be disastrous.\u201d<\/p>\n

THE AUTHORS, FREER AND MORGAN HARPER<\/strong>, sketch out an interesting history of how medicine went corporate and got big. After the advent of Medicare and Medicaid in the 1960s, economists stoked fears of patient overutilization of treatments and services. This led to a policy theory that private industry could make health care higher-quality and more efficient. Giving patients \u201cskin in the game\u201d in the form of co-payments and rationing care would also reduce utilization.<\/p>\n

The revolution was called managed care, and it was generally a gradual practice in corporate outsourcing, starting with the Health Maintenance Organization (HMO) Act of 1973, which led to exemptions of state corporate practice of medicine laws to allow private insurers to better direct care outcomes. \u201cAt the time this was maybe done in good faith,\u201d Freer said. \u201c[But] this approach has really failed on its own terms. It has not lowered cost or improved quality, and it has made a small number of companies a fortune \u2026 we\u2019re paying for this private apparatus to tell us we can\u2019t get the care that we need.\u201d<\/p>\n

Anybody can clearly see the results. Twenty-five years ago, there were no health care companies in the top 15 of the Fortune 500; today, there are six (insurance conglomerates UnitedHealth, CVS, and Cigna, and wholesale supplier giants McKesson, Cencora, and Cardinal Health). The Big Three wholesalers control 98 percent of the market; the above insurers own the Big Three pharmacy benefit managers (PBMs), which control 80 percent of the market. In almost half of U.S. metro areas, one insurance company controls half the market.<\/p>\n

It\u2019s not even right to call these companies insurers or wholesalers. UnitedHealth has 2,700 subsidiaries, and is the leading American employer of physicians and<\/em> the leading processor of claims. CVS is the dominant pharmacy chain and a PBM and a health insurer (Aetna) and a provider at its MinuteClinics. Drug wholesalers increasingly own physician practices, too. And then you have hospital conglomerates and private equity\u2013owned staffing firms. Forty years ago, 80 percent of doctors owned their own practices; today, 80 percent of doctors are employed by a large hospital network, an insurer, a wholesaler, or private equity. There were 161 private equity deals for dental practices\u2014just in 2024.<\/p>\n

Even the public side of health care is not immune from this agglomeration. Over half of Medicare beneficiaries are enrolled in private Medicare Advantage plans, which costs $76 billion a year above traditional Medicare. An even bigger percentage of Medicaid patients are in private managed care.<\/p>\n

Read more How Trump Is Destroying Detroit<\/a><\/p>\n

The consequences of handing over health care to Big Medicine have been immense. The cost of coverage through employers has tripled since 2005, and another 10 percent increase is expected next year. Prices charged to commercial insurers are double that of Medicare. When private equity buys out a physician practice, prices immediately jump 11 percent.<\/p>\n

Moreover, the health outcomes are garbage. Patients are routinely rejected access to brand-name prescriptions and charged more for deductibles and co-pays that worsen insurance coverage. \u201cPrior authorization,\u201d which means a delay or rejection of treatment, are carried out at a rate of 40 per physician per week. Hannah Garden-Monheit, a colleague of Freer\u2019s at AELP, tells the story of her late father being denied rehab after his leg was amputated and feeling like they couldn\u2019t talk about it because they might be denied cancer treatments, too.<\/p>\n

And the U.S. has a shortage of 96,000 physicians and countless numbers of vital drugs, too. Despite the stupendous spending, the system isn\u2019t even meeting current demand.<\/p>\n

When policymakers try to fix this madness, it\u2019s usually with well-intentioned tweaks that just open different loopholes. The report describes one critical example: the Affordable Care Act\u2019s medical loss ratio. On the surface, this sounds great: Large insurers have to spend at least 85 percent of premium dollars on actual medical care. But in practice, this has incentivized vertical integration among insurers and providers. \u201cIf we can\u2019t keep the profits, we can buy providers and overpay them,\u201d Freer explained.<\/p>\n

That\u2019s right. According to recent research, UnitedHealth pays providers owned by its affiliate Optum as much as 61 percent more than unaffiliated providers. This accomplishes two things. First, it moves money from one of UnitedHealth\u2019s pockets into the other, with no bearing on the parent company\u2019s profits. Second, it increases overall health spending, and since the insurance company gets to keep a percentage of that spending in profits, it increases UnitedHealth\u2019s earnings.<\/p>\n

This has become a standard practice, and it shows that incremental steps will ultimately fail to challenge the power and ingenuity of giant health care companies. \u201cIt\u2019s a real \u2018road to hell is paved with good intentions\u2019 situation,\u201d Freer said.<\/p>\n

THE SOLUTIONS THE REPORT OUTLINES<\/strong> are varied, but most of them are analogous to what the Glass-Steagall Act did for the financial industry. Preventing insurers and other middlemen from buying providers would end the absurdity of the same conglomerate on both sides of the transaction and close the medical loss ratio loophole. PBMs that control prescription transactions shouldn\u2019t also own pharmacies, the report recommends. A federal ban on corporate practice of medicine, as was enacted in Oregon last year, would separate private equity firms from owning doctors, hospitals, and nursing homes. (At the least, they could be held responsible for negligence or other actions leading to injury or death.)<\/p>\n

The report also counsels the need for public options that go beyond the insurance sector. Public PBMs have been incorporated at the state level, and they save states money while giving independent pharmacists higher reimbursements. Public manufacturing of prescription drugs is another option. And a reimagining of a public option is inherent in the report\u2019s endorsement of standardized pricing for health care treatment based on Medicare rates, eliminating the entire morass of billing and administrative negotiation from the system. \u201cI think those two pieces reinforce each other, public options and public standardized pricing,\u201d Freer said. \u201cProviders would have to compete on the quality of what they\u2019re providing rather than increasing market share.\u201d<\/p>\n

Freer also believes that investment is needed to ensure that competitive medicine can survive. That includes a revolving loan fund for independent practices so they aren\u2019t at the mercy of insurance claims, as well as more investment in public providers like community health centers. This may sound perverse given the $2 trillion a year the government already spends on health care. But, Freer says, \u201cit isn\u2019t just enough to break up Big Medicine, we have to think about how to rebuild a health care system to be friendlier to independent medicine.\u201d<\/p>\n

In the report\u2019s vision, health care would be consumer-friendly as well, by ending prior authorization and co-payments designed to ration care. The enormous savings from the other proposals can finance this.<\/p>\n

Polling consistently shows these ideas with 70 percent or more support across party lines, as the report indicates. The obvious reason that we still have the health system nobody wants is that Big Medicine is, well, big, and has a lot of power to maintain the status quo.<\/p>\n

That said, reform efforts are starting to bring policymakers more in line with public anger. \u201cThe states are really ahead of Congress,\u201d Freer said, citing novel approaches in Arkansas and Tennessee to break PBMs from pharmacies, direct price regulation of hospitals in Indiana, public PBMs in Ohio and Kentucky, and a public drug manufacturing plan in California. That most of these efforts are happening in red states shows that there is real opportunity for bipartisanship; many of the federal bills that mirror the report\u2019s recommendations have Democratic and Republican co-sponsors.<\/p>\n

\u201cFor a lot of time the conversation was how to preserve the Affordable Care Act, which did important things but essentially continued the managed care paradigm,\u201d Freer said. \u201cWe\u2019re starting to see the conversation shift to how to build on the ACA by moving away from that paradigm and really tackling the consolidation piece.\u201d<\/p>\n

Read more The House Always Wins, Even on House-less Kalshi<\/a><\/p>\n<\/div>\n


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Medicare for All without tackling the extreme consolidation in health care would just funnel money to corporate behemoths, a new report states.<\/p>\n","protected":false},"author":1,"featured_media":721,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[354],"class_list":["post-722","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-and-social-policy","tag-tagged-affordable-care-act-corporate-power-donald-trump-health-social-policy-health-insurance-hmos-medicaid-medicare-pbms-prescription-drug"],"yoast_head":"\nHealth Care Reform Needs More Than Universal Coverage - Frontier Housing Report<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/frontierhousingreport.com\/?p=722\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Care Reform Needs More Than Universal Coverage - 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