A PATHWAY TO VICTORY FOR DEMOCRATS IN 2026-28
DEMOCRATS have the opportunity to reconnect with their history of social progress for the American people by championing bold social programs that respond to widespread voter expectations.
There are several main reasons for that:
ACA is under attack for its costs and the resulting needed subsidies.
The 2026 elections are expected to center on affordability, and healthcare costs are a top-of-mind issue for many people.
Despite its out-of-control costs, the US healthcare and health insurance system is in urgent need of reform; a recent POLL (1) once more confirmed that a significant majority-65% of voters support Medicare for All -M4A;
This reform, if properly implemented, will yield substantial savings for everyone: the public, states’ and employers’ finances.
These savings can then be redirected to shore up the national retirement system, which is projected to run out of money by mid-decade.
1. KEEPING ACA SUBSIDIES IS A TRANSITORY FAIR AND WISE POLICY CHOICE...
More than three-quarters of Americans want the tax credits to continue, and 3 in 4 people said they will blame M. Trump or Republicans if they end, according to a KFF poll (2) conducted before the shutdown. KFF also found (3) that more than 3 in 4 ACA Marketplace enrollees live in states won by President Trump in the 2024 election.
“Health care costs are issues 1 and 2 for voters,” Jim Kessler, with the moderate Democratic group Third Way, said in a recent interview. “The real issue is that health insurance is too expensive for working people and they can’t afford it without some financial help,” said Drew Altman, president and CEO of KFF (Kaiser Family Foundation).
2. ...BUT THE US HEALTHCARE AND HEALTH INSURANCE SYSTEMS ARE FAILING
Year after year, inquiries show that the US healthcare and health insurance systems are not on par with those of other developed countries, as recent inquiries conducted by highly recognized, competent American institutions underscore:
Commonwealth Fund (4), titled “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System: The conclusion is: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance across domains, unlike the U.S., they have all met their residents’ most basic health care needs, including universal coverage.[…]
Especially concerning is the U.S. record on health outcomes, particularly in relation to how much the U.S. spends on health care. It indeed shows that the US system is uniquely costly; 2tem
The KFF Foundation (5), in its September 2025 study, states: “the fundamental pattern of the US having higher prices for healthcare services and using less care on average has persisted for many years.” […] The US spends nearly twice as much per person as the average of peer countries[…]
On page 91 of our book, we present IQVIA data showing that US patients use 30% LESS medicines than their Western European counterparts; In Part Two, Chapter three, we describe what we call the “US-specific insulin tragedy”, a specific example of how greedy actors rendered “a century-old drug” costing pennies to produce, too costly for many patients, leading to thousands of deaths! Five states recently sued Express Scripts, CVS Caremark, and OptumRx, as well as insulin manufacturers Sanofi-Aventis U.S. and Novo Nordisk, for these schemes (6), more than five years after a scathing report by the Senate Finance Committee exposed them!
There is even more to this; Recent studies reveal that:
- Healthcare denials are on the rise (7), especially in the very profitable Medicare Advantage market (8)
- This allows healthcare giants such as insurers or pharma companies to reap continually growing ultra-high profits (9), all while escaping taxes, thanks to DJT and Republican legislation. (On pages 4-5 of our book: “SOLVING THE U.S. DRUG CONUNDRUM”, we describe Big Pharma’s “performance” relative to tax dodging practice, using the 2017 DJT law).
- This massive transfer of financial risk has created a large and growing class of Americans who are ‘underinsured,’ (10)meaning their plan’s cost-sharing is unaffordable relative to their income. The consequences are predictable and harmful. In 2023, one in four insured adults delayed (11) or forwent some form of care due to cost, a choice that can worsen health and lead to more expensive complications down the road.[…]
- There is a vast, often overlooked consequence to high healthcare prices: In the private sector, the trade-off between health benefits costs and wage rises has been inflicting economic harm (12). A study shows that healthcare costs have been eating into workers’ incomes. Another study (13), published in JAMA on January 16, 2024, found that in 1988, health care premiums accounted for an average of 7.9% of total worker compensation; by 2019, that number had jumped to 17.7%.
If ESI costs had remained at the same proportion as in 1988, the average family with ESI could have earned $8,774 more in annual wages by 2019”.
3. ...2026 IS AT A TIPPING POINT
The abolition of ACA subsidies will dramatically and devastatingly amplify this underlying trend. Regarding ESI, specialists expect that 2026 health insurance premium increases will be exceptionally high (14), by 9%, and employers will seek to reduce this rate to 7% through corrective policies (which will likely include lowering employee benefits…).
Regarding ACA, while premiums charged by insurers would grow on average by 26%, ACA enrollees could see their payments increase (15) by an unreasonable, explosive 114%!
KFF recently reported (16) that approximately half of adults with ACA marketplace coverage are small-business owners, employees, or self-employed individuals.
A January KFF poll (30) found that healthcare costs are the top household expense on which the public worries.
4. ... WITH A MASSIVE IMPACT ON THE US ECONOMY’S COMPETITIVENESS
This will accelerate a trend that some employers anticipated as early as 2021: the costs associated with their employees’ health insurance becoming unsustainable. An extract of a 2021 survey (17) by KFF and PBGH (Pacific Business Group on Health) on executives of prominent corporations providing healthcare coverage to their employees had the following findings: “The responding employers largely believe that the cost of health benefits is too high. While in general respondents felt that employers individually or collectively can have an impact on health care costs, more than four in five believe that the cost of providing health benefits will become unsustainable at some point in the next five to ten years, (2026-2031) and that there will need to be a greater role for government in providing coverage and controlling costs. Respondents generally expressed some agreement with a variety of policies that would expand the government’s role in health benefits, including limiting provider prices in non-competitive situations and expanding options for employees and others to enroll in public programs.”
There is even greater support among SMB owners, who expect policymakers’ actions. (18). Other experts’ papers (19) show that, in fact, “self-insured” employers, despite all the buzz from specialized consultants, lack the leverage to negotiate healthcare prices efficiently.
Warren Buffett, on his part, once famously said: “Medical costs are ‘the tapeworm’ of the US Economy”.
5. THE US HEALTHCARE SYSTEM IS IN URGENT NEED OF REFORM
We see four main factual reasons for that:
First, the current US healthcare system is not only horribly complex (and complexity is the enemy (29) of affordability, specialists recall…) to navigate for patients and doctors (see also pages 71 to 74 of our book about prior authorizations, for instance); it is also uniquely costly (20), with a 66X growth since 1970 (!): $5.3 trillion, with out-of-control administrative costs: between $1.32 and $1.9 trillion. This represents 25-35% of the overall “bill”, while the OECD average is 9%. At this level, ten years of potential savings on administrative costs alone would amount to between $7.8 trillion and $12 trillion.
IT IS HENCE ABSURD TO REFUSE M4A UNDER THE PRETENSE THAT IT IS TOO COSTLY; IT’S QUITE THE OPPOSITE: prices and admin costs will be down, hence reducing the needed subsidies! Democrats have their own “DOGE” here, of private bureaucracies extorting money from sick people to endlessly increase their already exorbitant profits, sometimes through outright fraud.
Secondly, as it is working today, health insurance, when accurately analyzed, is not primarily a cost-control mechanism; A specialist like Ms Christine DEACON (who wrote the preface to our book) recently asserted:
“In most cases, insurance is a cost-layering mechanism that adds administrative drag, network margins, actuarial loads, rebate arbitrage, and self-dealing.“ (One should add: profits for a tiny minority. There is indeed no quadruple or triple aim here; just one: maxing out their still-huge profits!
Third, you don’t really need “health insurers” here: there is no real risk to insure 340 million people; at this population level, premiums are highly predictable. We provide more explanation in a box on page 182 of our book. You will find additional information in the extensive literature on the Central Limit Theorem and the Normal, or Gaussian, distribution law.
Fourth and finally, contrary to what is alleged by a cohort of pseudo-specialists, that the solution would lie in “aligning incentives” between insurers and their “clients”, we contend that these interests are radically opposed, as history has abundantly shown; more explanation in the box on page 183 of our book. A recent, illuminating example of that is the recent move (21) several insurers made to avoid costly Medicare enrollees, to say nothing about the massive scam (26) UHG mounted over the years, gaming the Medicare Advantage scoring system, to maximize its profits, with damageable consequences, as specialists (27) point out: 2024 NHE high growth rate (7.2%) may well have been pushed upwards by these practices. And UHG is not the only one (28) engaging in these harmful practices.
6. ...THIS REFORM IS EXPECTED BY A HUGE MAJORITY OF AMERICANS
It is time to conclude the last few years. For the upcoming elections, you must propose solutions that have proven themselves elsewhere (in Part Three of our book, we make a short presentation of the systems in place in three European countries: Germany, the UK, and France); a solution that the public expects: MEDICARE FOR ALL, with a public option as an intermediate step in 2026-2028. This reform will meet overwhelming support, as a specialist like Paul Keckley recently wrote: “[…]
“However, most Americans also believe that healthcare is a fundamental right and that the government should guarantee access through universal coverage. Having private insurance is not the issue: having insurance that ensures access to doctors and hospitals when needed reliably and affordably is the unmet need.”
Doing so:
- You will get the votes you need, and your Party will regain favorability (today, only 27% of Americans identify with Democrats (22), while 45% identify as independents…)
- You will be able to counter the billionaire’s (23) growing impact on US politics
- And finally, the resulting savings will enable you to resolve the Social Security issue, whose outlook is alarming.
It’s time for the Democratic Party to reconnect with its history by enacting bold, popular social programs that benefit the American people!
