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In the United States today, as rising healthcare costs for individuals and government alike approach a crisis point, major systemic change enacted by legislation feels utopian. Behemoths stalk the healthcare landscape: Mega-insurers control major PBMs, large numbers of physician practices, and tech tools to maximize billing; hospital systems dominate their regions; pharmaceuticals maximize pricing power over fractured payers; private equity firms roll up major physician specialist practices within target markets and dominate target services like hospice and dialysis.
These powerful actors deploy our corrupt campaign financing rules to deter elected officials from both parties from enacting legislation that would fundamentally threaten their current revenue sources. A single-payer system, or a strong public option available to all, or a national system of all-payer rate-setting, are not likely to happen this side of revolution (including, on the hopeful side, political revolution).
In tacit acknowledgment of those facts, Families USA has launched Stop the Bleed — almost literally a triage campaign to provide some cost relief to the people of this country. The campaign invites healthcare advocates — and anyone who wants to sign up — to ask candidates for electoral office from both parties and at any level what they propose to do to control healthcare costs.
Families USA is logging the responses and will begin publishing them in April. The emphasis is on curbing corporate “greed” in all sectors of the healthcare industry. The actual question prompt for participants to ask candidates is, “What will you do to hold healthcare corporations accountable for high costs?”
I spoke to Sophia Tripoli, Senior Director of Health Policy at Families USA, about the campaign’s structure and what it suggests about the current path to meaningful healthcare reform.
I asked Tripoli whether she envisioned questioners and candidates focusing on big-picture proposals or more incremental ones. The answer was essentially both/and: “Anything from Medicare for all to health savings accounts and everything in between.” For as many candidates as possible, the idea is to “have something on the record” and collect “policies to chip away at this problem.”
While the project structure may lean toward the incremental proposals, Tripoli said that the “bigger existential question” is that for all industry segments, “All the economic incentives about getting bigger and bigger rather than delivering better care.” By measures small and large, Families USA wants to get candidates to commit to reining in corporate greed.
The challenge to candidates is nonpartisan by design. “Voters across the political spectrum are hungry for bold reform, frustrated with greed,” Tripoli said. Candidates from both parties need to connect with that hunger, she suggested.
Tripoli noted that bipartisan support has been crucial to significant incremental reform — most recently, to reform of Pharmacy Benefit Manager (PBM) pricing practices enacted last month, requiring flat-fee pricing and 100% pass-through of rebates negotiated by the PBMs. Other areas with potential for bipartisan action include site-neutral payments — curbing hospitals systems’ opportunities to charge Medicare higher rates for services performed at hospital outpatient centersthan for the same services provided in doctors’ offices ( e.g., for drug administration, as just implemented by CMS) — and anticompetitive contracting practices, for example by dominant hospital systems requiring insurers that contract with any providers in the system to contract with all of them.
Families USA has put out its own menu of incremental steps to improve affordability, with measures to increase transparency and accountability; reduce opportunities for various players to game pricing (site-neutral payments for providers, reformed risk adjustment and benchmarks for Medicare Advantage plans, patent loophole closure for drug companies); reduce conflicts of interest and bad incentives (RUC reform, curbs to anticompetitive pricing, transparency about private equity ownership); and provide direct relief to working families (extend the enhanced ACA tax credits that expired on Jan. 1, 2026; impose price caps — possibly on a state level, as Maryland does and as Merrill Goozner recommends; extend Medicare-negotiated prices to the commercial market). A more detailed and small-bore-by-design menu is the 1% Steps for Health Care Reform project compiled by a team of academics led by Zack Cooper of Yale.
The Stop the Bleed challenge should also be put forward at the state level, where there is a good deal of action, as a recent brief from the Georgetown Center on Health Insurance Reforms (CHIR) details. Initiatives include various types of price curbs on hospitals, including annual caps on reimbursement growth, ramped-up antitrust enforcement, and price transparency measures.
The Stop the Bleed campaign invites candidates to provide open-ended responses to a single question, “If elected, what will you do to stop the bleed, bring down costs, and crack down on corporate greed in health care?” It seems to me that campaign participants will have to find ways to follow up to get meaningful answers from most candidates. It would be easy for a Democrat to respond, say, that “I’m for Medicare for All, and in the shorter term, I will fight to restore the ACA enhanced subsidies and roll back Medicaid work requirements and other Medicaid cuts,” or for a Republican to say, “I will work to strengthen Medicare and Medicaid by cracking down on fraud and to increase competition and give consumers more choice and control over their healthcare costs.”
As the reform overviews and menus above demonstrate, there are ample opportunities to get candidates beyond that boilerplate. There may be a certain tension between chipping away at the myriad opportunities for healthcare corporations to forestall competition, game payment systems, collect rents, and exploit opacity to price at will — and working to create a system that fundamentally reforms incentives so that all players are not geared toward maximizing revenue. But here’s hoping that advocates and activists find ways to get some serious discussion and commitment from candidates at all levels.
Image by Pearson Scott Foresman.
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