The U.S. health care system is at a reckoning point. Following decades of unchecked consolidation and vertical integration, Big Medicine — insurance conglomerates, Big Pharma manufacturers, pharmaceutical middlemen, mega hospitals, and private equity-backed practices — controls nearly every aspect of this system. As a result, health care costs have skyrocketed, even as both patient outcomes and physician supply relative to demand decline. 

Between 2005 and 2025, the annual cost of employer-sponsored family coverage nearly tripled, from $12,214 to $35,119, and it continues to rise. Employer health care costs are projected to increase 10% — to more than $17,000 per employee — this year alone, and employers report shifting these costs to workers in the form of higher deductibles, lower wages, and more frequent layoffs.  

The passage of President Donald Trump’s and congressional Republicans’ One Big Beautiful Bill Act has only exacerbated cost and coverage issues, pushing an already strained system to the brink. The typical family enrolled in an Affordable Care Act (ACA) health plan is expected to pay $3,735 more in annual premiums as a result of the legislation. It is also estimated that nearly 5 million Americans will lose coverage entirely this year for the same reason, fueling uncompensated care costs at hospitals and further driving up premiums for those who remain insured. 

All this spending might be worth it if the U.S. health care system delivered better patient outcomes. Instead, both insured and uninsured patients alike delay or forgo care because of cost, with predictably tragic — and too often fatal — results. Americans’ life expectancy, maternal health, and other quality metrics fall far short of those of peer nations. 

health care practitioners are also leaving clinical practice in droves, unable to continue dealing with private insurers that dictate unsustainably low payment rates, impose increasing administrative burdens, and interfere with clinical decision-making. As a result, the United States faces a shortage of more than 96,000 physicians — mostly in primary care — and the average time to schedule a doctor’s appointment is now more than four weeks. Independent providers, especially, are forced to shutter, stranding patients in care deserts or leaving them with only corporatized options that charge higher prices for lower-quality care. 

There’s increasingly bipartisan consensus, among both Americans and their representatives in Washington, that this spiraling crisis cannot be fixed without addressing the power of Big Medicine over our health care system. This agenda lays out bold, structural policy solutions to break up Big Medicine and rebuild a more effective U.S. health care system, one that delivers better care at lower costs.

Our proposed reforms would wrest control over our health care system from Big Medicine, whose fiduciary duty is to investors, and restore it to patients and the practitioners who have sworn an oath to care for them. Research shows that at least 15% of U.S. health care spending goes toward Big Medicine administrative waste, a far larger share than in peer nations, where overhead accounts for just 1% to 4% of overall spending. These reforms could save Americans up to $795 billion annually — or more than $6,000 per household — by reducing such administrative waste. And that’s before accounting for hundreds of billions of dollars of savings from increased competition, quality of care, and clinician capacity.