When Healthcare Reform Slows Down...
- outreach0686
- 3 days ago
- 5 min read
Healthcare reform often comes with urgency. Patients are struggling with rising premiums, high deductibles, and prescription drug prices that feel untethered from reality. Understandably, many people ask why Congress does not simply “fix” the system more quickly.
Yet it may be worth considering whether slowing down—especially in the Senate—could actually benefit patients. Large-scale healthcare change is difficult precisely because it reshapes how money, power, and decision-making flow. A pause can create space to examine whether proposed reforms truly change the structure of healthcare, or whether they unintentionally reinforce the same dynamics that have driven costs higher over time.
Change is hard. But in healthcare, rushing change can sometimes preserve the status quo rather than transform it.
Understanding the Current Healthcare Financing Model
In today’s system, much of the financial support intended to help patients afford healthcare flows first to insurance companies. Government subsidies are largely routed through premiums and cost-sharing mechanisms, meaning insurers receive payments directly while patients experience the system through monthly premiums, copays, and deductibles.
This raises an important structural question:
When healthcare dollars are routed first to insurers rather than patients, who ultimately controls pricing and access?
When subsidies are guaranteed and paid directly to plans, it is reasonable to ask whether this structure:
Reduces pressure to control premium growth
Allows prices to rise with fewer natural constraints
Shifts leverage away from patients and physicians
These are not questions of intent or blame, but of incentives. Systems tend to respond to how money flows through them.
A Proposal Framed Around Patients: The Great Healthcare Plan
Against this backdrop, President Trump has called on Congress to consider what has been described as the Great Healthcare Plan. The plan is presented as a comprehensive proposal aimed at lowering costs and increasing transparency, with a central goal of placing greater control and healthcare dollars directly in the hands of patients.
As described, the plan focuses on several key areas.
Lowering Prescription Drug Prices
The proposal outlines mechanisms intended to reduce drug costs, including:
Codifying Most-Favored-Nation pricing, so Americans pay prices comparable to those in other developed countries
Expanding access to safe over-the-counter medications where appropriate
Increasing competition to reduce costs
The underlying question for patients is simple:
If Americans pay more for the same medications than patients elsewhere, is there room for structural change?
Reframing Insurance Subsidies: Where the Dollars Go First
One of the more significant ideas described in the plan involves redirecting how healthcare subsidies are delivered.
Rather than funneling taxpayer subsidies directly to insurance companies, the proposal calls for sending financial support directly to eligible Americans, allowing patients to decide how to use it— whether for insurance coverage, healthcare services, or medications.
This reframing invites reflection:
Does sending subsidies to insurers strengthen insurance companies’ leverage over prices?
Would directing funds to patients change how insurers compete and price their plans? The plan also references ending PBM kickbacks, funding cost-sharing reductions to lower premiums, and reducing wasteful spending again framing these changes as ways to rebalance incentives rather than expand bureaucracy.
How the Plan Is Described as Being Implemented
Supporters of the proposal describe a multi-layered approach to implementation.
Executive Authority
Some elements rely on executive action where federal authority already exists, including:
Conditioning Medicare and Medicaid participation on compliance with price transparency rules
Using federal purchasing power to enforce drug pricing benchmarks
Increasing oversight of PBM practices in federal programs
These measures are described as enforceable through existing agencies without requiring new legislation.
Congressional Action
Other elements, particularly the redirection of subsidies, would require Congress to act. This is where legislation becomes slower and more complex, and where debate in the Senate has continued.
Here, another patient-centered question emerges: Is it better to pause and examine how subsidies are structured than to rush changes that may preserve insurance-centered control?
Health Savings Accounts as a Patient-Held Tool
A key feature described in the plan is expanded use of Health Savings Accounts (HSAs). HSAs are presented as a mechanism through which healthcare dollars can be:
Owned by patients
Used for premiums, care, and medications
Portable and not tied to a specific insurer
This structure raises a fundamental question about healthcare economics: Would prices behave differently if patients, not insurers, were the primary holders of healthcare dollars?
When patients can take their funds with them, competition may shift toward transparency, value, and service rather than complexity.
Transparency and Accountability as Cornerstones
Another central theme of the proposal is mandatory transparency. The plan describes requirements for:
Plain-English insurance disclosures
Public reporting of profit margins, denial rates, and wait times
Upfront posting of real prices by providers
Compliance would be enforced through civil penalties and, in some cases, access to federal programs such as Medicare and Medicaid.
From a patient perspective, the question is practical:
How can patients make informed choices if prices and policies are not visible until after care is delivered?
Why a Senate Pause May Serve Patients
Legislation touching on affordability and subsidies has passed the House but remains unresolved in the Senate. Rather than viewing this solely as gridlock, it may be helpful to ask whether this pause allows time to examine whether reforms genuinely shift power toward patients.
A slower process can help ensure that:
Dollars do not continue flowing primarily to insurers by default
Transparency is meaningful, not symbolic
Reform addresses cost drivers rather than masking them
Sometimes, slowing down is not resistance to change—it is an opportunity to ask better questions.
A Patient-Centered Reflection
At its core, patient-centered healthcare is not about political ideology or legislative speed, it is about structure and alignment. It asks fundamental questions that shape every experience of care:
Who holds the healthcare dollars?
Who sets the prices?
Who ultimately makes the decisions?
If reform is to truly serve patients, those answers must consistently point back to patients and the physician-patient relationship—not to opaque systems or distant intermediaries. Real reform reshapes incentives, restores transparency, and returns agency to the people seeking care and the physicians providing it. In that light, taking the time to examine, refine, and thoughtfully implement change is not delay—it is discernment. And discernment, especially in healthcare, may be one of the most patient-centered choices we can make.
Sources:
White House Health Care Executive Actions and Policy Proposals Official summaries and fact sheets outlining healthcare-related executive actions, including price transparency requirements, drug pricing initiatives, and patient-directed policy frameworks.
Centers for Medicare & Medicaid Services (CMS)
Hospital and Insurance Price Transparency Rules
Federal regulations and guidance governing hospital price transparency, insurer disclosure requirements, and enforcement mechanisms tied to Medicare and Medicaid participation.
Congress.gov Legislative Tracking for H.R. 6703 and H.R. 1834
Official legislative records documenting House passage, Senate status, and procedural actions related to healthcare affordability, premium subsidies, and ongoing negotiations.
U.S. Department of Health and Human Services (HHS)
Pharmacy Benefit Manager (PBM) Oversight and Drug Pricing Policy
Regulatory materials and policy discussions addressing PBM practices, drug pricing authority in federal programs, and patient cost-reduction strategies.