It is that time of year. People are signing up for health insurance, or switching plans, and the prices are nuts. I keep seeing people say they are paying thousands of dollars a month for a family of three. There is a lot of debate about renewing the subsidies.
What we actually want is cheaper healthcare, not another shift in who pays for it, from patients to insurers to taxpayers. We need to dramatically reduce the cost of producing care.
The United States restricts the supply of care and then acts surprised when the remaining care is expensive. We make it hard to open facilities, hard to train clinicians, hard to move a license across a state line, and easy for a dominant hospital system to charge two prices for one service. Subsidies change who writes the check. They do not, by themselves, make the service cheaper to deliver.
We need abundance in healthcare, not more government subsidies.
Why is healthcare so different?
In a working market, buyers do not need a company’s internal costs. They need to know what they are buying, what it costs, whether it is any good, and what else they could buy instead.
If one hospital charges $5,000 for a procedure and another charges $3,000, I do not care which one spends more on administrators, nurses, buildings, or executive pay. I care whether the cheaper hospital’s care is as good. Competition is what pushes a business to find the savings. Patients should not have to audit the books to make that happen.
Healthcare does not work that way, for a few distinct reasons.
Government is both the regulator and a huge customer
Medicare and Medicaid pay for a large share of care. Spending taxpayer money comes with a real duty to know what is being bought and to watch for fraud. Medicare-certified hospitals already submit an annual cost report to CMS. Those reports let Medicare administer the program. They are not the same as requiring every hospital to publish a detailed breakdown of its internal expenses.
Price competition is weak
An MRI should be ordinary shopping: more than one place to go, a price you can see, some relationship between that price and the cost, and the option to go somewhere else. In healthcare the network may limit the choices, the negotiated price is often hidden, and a deductible makes the bill hard to predict. There may also be almost no one to switch to. KFF found that 97% of U.S. metropolitan areas had highly concentrated markets for inpatient hospital care in 2024.
Emergencies cannot be shopped. A lot of care can.
Someone unconscious after a car accident cannot compare emergency-room prices. That is a real reason for rules that do not depend on shopping. It does not describe an MRI, a blood test, physical therapy, an elective surgery, or a dental cleaning. People can compare those in advance. Emergency care and shoppable care are different problems.
Rules and mergers both keep rivals out
Certificate-of-need laws, occupational licensing, and scope-of-practice limits make it harder for a new provider to open. Less entry means less pressure on prices. Government is not the only cause. Hospital mergers, insurer networks, and the cost of running a specialized facility do the same thing.
Eight ways to make care cheaper to produce
01
Make it dramatically easier to open competing hospitals and clinics
There are laws that make this harder. We could make it easier. If a qualified operator wants to open a hospital, a surgery center, or another facility, the default should be permission, not a political process that existing hospitals can use to keep rivals out.
02
Stop hospital systems from using market power to block competition
Large systems can demand unreasonable prices and write contracts that keep insurers from steering patients to cheaper competitors. Anticompetitive and monopolistic practices should be reduced or banned.
03
Make it easier to become a doctor, nurse, or other clinician
We restrict the supply of healthcare. There are not enough medical residency positions. Qualified nurse practitioners and physician assistants face unnecessary scope-of-practice limits. Professional licenses are hard to transfer across states. Not every procedure requires a physician, and not every appointment needs to happen in a hospital.
04
Pay the same price for the same service
This is site-neutral payment. An independent clinic can perform a routine service for $300. If a hospital buys that clinic, the same service can be billed at $600 because it now qualifies for a hospital outpatient facility payment. That is silly. The building’s owner should not double the price of an identical service.
Independent clinic
$300
Same service, after a hospital buys the clinic
$600
05
Make prices visible before treatment, and share the savings
Transparency alone is not enough. Patients need a financial reason to choose a lower-cost provider, and insurers need to encourage it. If I shop around and find an MRI for $100 instead of $500, a portion of that savings should land in my pocket. Emergency treatment obviously cannot depend on shopping around.
06
Shift suitable care to cheaper settings
Make it easier to deliver the right services through independent clinics, ambulatory surgery centers, retail clinics, telehealth, and home-based care. A hospital is the correct setting for some care. It is an expensive default for care that does not need one.
07
Make drug competition actually work
Accelerate safe generic and biosimilar approvals, challenge tactics that improperly delay competition, and fix incentives that favor expensive drugs over cheaper equivalents. This will not solve healthcare costs by itself. Retail prescription drugs accounted for only about 9% of overall health spending in 2024.
08
Cut paperwork that does not improve care
Not all paperwork is bad. Infection control, safety reporting, and independent clinical oversight have real value. The target is documentation that does not measurably improve patient outcomes, especially when staff re-enter information already captured during care. An hour of unnecessary data entry is an hour not spent seeing another patient.
So which politicians are working on this?
Quite a few, and the interesting part is how bipartisan the list is. I found elected Republicans and Democrats proposing legislation that matches almost every one of these eight ideas. Some proposals have become law.
There is not one major politician I found championing the entire agenda as a single platform. Several are remarkably close, especially on competition, hospital pricing power, the supply of clinicians, and administrative waste.
These are legislative efforts, not campaign sentences. The details matter. Some bills are narrow. A few take a more interventionist route than the rest of this argument. Status below is as of November 2026.
| Idea | Who is acting | Status |
|---|---|---|
| Make opening hospitals easier | ||
| Fight hospital contracting power | ||
| Train more physicians | ||
| Site-neutral payments | ||
| Price transparency | ||
| Cheaper settings for care | ||
| Generic and biosimilar competition | ||
| Reduce paperwork |
The closest matches
Ideas 2 and 5 · Bill introduced
Jon Husted on hospital contracts that suppress competition
In March 2026, Senator Jon Husted, a Republican from Ohio, introduced the bipartisan Healthy Competition for Better Care Act. It targets contract terms powerful hospital systems use in negotiations with insurers:
- All-or-nothing contracts. An insurer must include every hospital in a system if it wants access to one important hospital.
- Anti-steering clauses. Contracts restrict insurers from directing patients toward cheaper facilities.
- Anti-tiering clauses. Insurers cannot give lower-cost hospitals better placement in their plans.
- Most-favored-nation clauses. Contract terms can discourage competing providers from offering lower prices.
The sponsor’s announcement also covers gag clauses that keep price information from the people paying the bill. The House companion has Republican and Democratic sponsors, including Jodey Arrington of Texas, Donald Davis of North Carolina, Rick Allen of Georgia, and Chuck Edwards of North Carolina.
This is almost precisely the point of stopping existing systems from using market power to block competition. Husted’s announcement is the short version. The bill is S. 4027.
Idea 4 · Bipartisan framework
Bill Cassidy and Maggie Hassan on site-neutral payment
In November 2024, Senator Bill Cassidy, a Republican from Louisiana, and Senator Maggie Hassan, a Democrat from New Hampshire, released a framework for Medicare site-neutral payment. It proposes equal Medicare payments for comparable services across appropriate settings, and it would remove exceptions that let hospital-owned outpatient facilities charge more. The point is to shrink the financial reason for a hospital to buy an independent practice just to collect a higher rate.
That is the $300-versus-$600 scenario. The framework was not introduced as one comprehensive bill. Narrower site-neutral policies have moved in pieces, and both the Obama and Trump administrations put versions of the idea in budget proposals. The Cassidy–Hassan announcement and the framework itself are the sources. The Bipartisan Policy Center was among the groups that endorsed the approach.
Idea 1 · Law enacted
Wes Climer and South Carolina’s hospital-building reform
This one is law, not a press release. State Senator Wes Climer, a Republican, was a lead sponsor of South Carolina S. 164, which substantially eliminated the state’s certificate-of-need rules. Those rules required healthcare providers to demonstrate a government-recognized “need” before opening or expanding many facilities. Existing hospitals could use that process to object.
The 2023 law, signed as Act 20:
- Removed certificate-of-need requirements for many facilities, including ambulatory surgery centers.
- Phases out the requirement for most new hospitals and hospital bed expansions on January 1, 2027, with exemptions already in place for some relocations, mergers, and counties without a hospital.
- Kept the requirement for nursing homes and home health agencies.
The goal is more capacity and more competition. Repealing a permission slip does not guarantee a new hospital opens. It removes a barrier that was designed to stop one. Governor McMaster’s signing announcement has the official summary.
Idea 3 · Bill introduced
Terri Sewell and Brian Fitzpatrick on training more doctors
In June 2025, Representative Terri Sewell, a Democrat from Alabama, and Representative Brian Fitzpatrick, a Republican from Pennsylvania, announced the Resident Physician Shortage Reduction Act. It was introduced as H.R. 4731.
14,000
additional Medicare-supported residency positions over seven years, 2,000 a year, aimed at shortage areas and hospitals with limited training capacity.
That attacks one of the supply bottlenecks. It does it by expanding federal financing for residency training, so it is not pure deregulation. The objective is still more physicians, not another subsidy for patient spending. Sewell’s announcement lays out the design.
Scope of practice is mostly a state decision. California’s A.B. 890, signed by Governor Gavin Newsom in 2020, created a path for certain nurse practitioners to practice without the old physician-supervision arrangement, with training and setting requirements still attached. Utah already recognizes full practice authority for nurse practitioners.
Idea 7 · Bills advanced in committee
Amy Klobuchar, Chuck Grassley, and Mike Lee on drug competition
In March 2025, Senator Amy Klobuchar, a Democrat from Minnesota, and Senator Chuck Grassley, a Republican from Iowa, introduced bills aimed at tactics that delay cheaper drugs. One limits pay-for-delay deals, where a brand-name manufacturer compensates a generic or biosimilar maker to postpone competition. Another, the Stop STALLING Act, targets the use of FDA petitions to obstruct competing approvals. The Senate Judiciary Committee advanced the package in April 2025. The pay-for-delay bill is S. 1096. Klobuchar’s release and the Judiciary Committee release describe both.
There is a Utah connection. In June 2025, Senator Mike Lee introduced the bipartisan Biosimilar Red Tape Elimination Act with Maggie Hassan and others. It would treat an FDA-licensed biosimilar as interchangeable, instead of requiring a separate switching study before a pharmacist can substitute the cheaper product. The Senate HELP Committee reported it in July 2026. Lee’s announcement is the plain-language version.
More of the map, including a law Utah already passed
Idea 5 · State law, 2018
Utah already created a way to pay patients for shopping
In 2018, Utah passed H.B. 19, Health Insurance Right to Shop Amendments. It set up a framework for insurers to reward members who choose high-quality, lower-cost providers. The rewards can take different forms.
The $100 MRI instead of the $500 MRI, with some of the difference coming back to the patient, is not a hypothetical. Utah legislated in that direction.
The caveat matters. A legal framework does not mean every Utah insurance plan offers a meaningful shared-savings benefit today. The statute made the tool available. Plans still have to use it.
Idea 5 · Reported by Senate HELP, July 2026
Roger Marshall and John Hickenlooper on price tags
Their Patients Deserve Price Tags Act, S. 2355, would expand price disclosure for hospitals, insurers, laboratories, imaging facilities, and ambulatory surgery centers. Chuck Grassley is an original cosponsor. The Senate HELP Committee reported the bill in July 2026 and placed it on the Senate calendar. That is further than introduction, and it is not enactment. Marshall’s announcement explains the disclosure rules.
Idea 6 · Bills introduced
Hospital-level care at home, and telehealth that does not expire
Senator Tim Scott, a Republican from South Carolina, and Senator Raphael Warnock, a Democrat from Georgia, introduced the Hospital Inpatient Services Modernization Act to extend Medicare’s ability to cover qualifying hospital-level treatment delivered at home. Their announcement is from July 2025.
Separately, Senator Brian Schatz of Hawaii and Senator Roger Wicker of Mississippi led the CONNECT for Health Act with 60 Senate sponsors, a bipartisan proposal to make Medicare telehealth flexibilities permanent. Schatz’s release lists the sponsors. Telehealth and home care are ways to deliver care outside a traditional facility. They are cheaper only when the total cost is actually lower for a comparable outcome.
Idea 8 · Bills introduced
Sheldon Whitehouse, Mark Warner, and Roger Marshall on paperwork
In February 2026, Senator Sheldon Whitehouse, a Democrat from Rhode Island, reintroduced the Prior Authorization Relief Act. It would audit Medicare Advantage prior-authorization rules, standardize the common ones, and exempt some providers in two-sided value-based models. Whitehouse’s release is the source.
Senator Mark Warner, a Democrat from Virginia, and Senator Roger Marshall, a Republican from Kansas, have pushed the Improving Seniors’ Timely Access to Care Act, which would require an electronic prior-authorization process in Medicare Advantage, with standard transactions and deadlines. Representative John Joyce, a Republican from Pennsylvania, sponsored the House companion. Representative Kim Schrier, a Democrat from Washington and a physician, has co-led a separate prior-authorization bill, the Reducing Medically Unnecessary Delays in Care Act. The shared idea is the right one: clinicians should spend less time resubmitting the same documentation and waiting on an approval that was going to come anyway.
Who is closest to the whole agenda?
Nobody owns all eight ideas. If I were looking for people already closest to a healthcare abundance agenda, I would start here.
| Politician | Party | Why they are on the list |
|---|---|---|
| Bill Cassidy | R | Site-neutral payments, and the Senate HELP chair who moved price-transparency and biosimilar bills forward. |
| Jon Husted | R | A direct ban on hospital contract terms that keep insurers from sending patients to cheaper providers. |
| Brian Fitzpatrick | R | A bipartisan plan, with Terri Sewell, to add residency slots and train more physicians. |
| Maggie Hassan | D | Site-neutral payments with Cassidy, and a cosponsor of Mike Lee’s biosimilar bill. |
| Elizabeth Warren | D | An aggressive attempt, with Josh Hawley, to unwind consolidated ownership across insurers, pharmacies, and providers. |
| Mike Lee | R | Cutting the extra regulatory step that keeps approved biosimilars from being substituted for the expensive original. |
Warren and Hawley’s February 2026 Break Up Big Medicine Act is the sharpest example of the tension inside this coalition. It would prohibit certain combinations of healthcare provider, insurer, and pharmacy-benefit-manager ownership. Hawley’s announcement describes the divestment rules. That is a real attempt to deal with consolidation. Ownership bans can also conflict with making it easier to start and operate medical businesses. Competition policy and entry policy are not the same tool.
What is still missing
Nobody has assembled the eight ideas into one platform
There is bipartisan support for individual pieces, and very little unified argument about increasing the supply of healthcare and making delivery structurally cheaper.
A lot of the action is Medicare-only
Site-neutral Medicare payments can reduce federal spending and patient cost-sharing. They do not automatically force commercial insurers to pay the same amount for the same service in different buildings.
Supply-side reform is split between states and Congress
- States largely control facility approval, professional licensing, and scope of practice.
- Congress influences residency financing, Medicare payment, and parts of competition policy.
- Federal and state antitrust authorities can challenge anticompetitive conduct.
There is no single statute that fixes the supply problem.
A bill is not the same thing as a lower price
Dropping a certificate-of-need rule can allow a new competitor. It does not guarantee one opens. Expanding scope of practice can improve access, and the right boundary still depends on training, the service, and patient safety. Home-based care saves money only when its total cost is lower for a comparable result.
A serious abundance agenda would publish the outcomes it is trying to move: prices, new provider entry, wait times, administrative hours, and quality of care.
The coalition is already there
I looked for a single champion and did not find one. I did find hospital-competition legislation, a site-neutral framework, a residency expansion, drug-competition bills, a price-transparency bill that cleared a Senate committee, a state that tore up most of its certificate-of-need rules, and a Utah law that lets insurers pay patients for choosing cheaper care.
What is frustrating is that the work is scattered across dozens of bills. I have not found a prominent politician who has made the entire agenda — more healthcare supply, more competition, and more productivity — the centerpiece of a healthcare platform.
I would like to see that platform. Call it a healthcare abundance agenda. The goal is care that is fundamentally cheaper to produce and deliver.
We should debate who pays. We should put at least as much energy into why it costs so much in the first place.
This agenda is less partisan than the healthcare argument usually sounds. Market-oriented Republicans want fewer barriers to entry. Progressive Democrats want to break monopolistic healthcare companies. They disagree about coverage, subsidies, and the government’s ultimate role. They have real common ground on competition and waste.
Making healthcare cheaper to produce is a goal both parties can pursue, whatever system they prefer for paying the bill.
Sources
- Jon Husted, Healthy Competition for Better Care Act and S. 4027
- Cassidy–Hassan site-neutral framework and the policy paper
- South Carolina certificate-of-need repeal and S. 164
- Sewell and Fitzpatrick residency bill and H.R. 4731
- Klobuchar and Grassley drug-competition bills, S. 1096, and Mike Lee’s biosimilar bill
- Utah H.B. 19 (2018)
- Patients Deserve Price Tags Act and S. 2355
- Hospital at home and CONNECT for Health Act
- Whitehouse prior-authorization bill and Warner and Marshall prior-authorization bill
- California A.B. 890 and Break Up Big Medicine Act
- CMS hospital cost reports
- KFF, hospital market concentration in metropolitan areas, 2024