Transparency in theory is not reform
I have long argued that the central failure of American healthcare is not a lack of spending or innovation but a persistent mismatch between rhetoric and execution, particularly when it comes to transparency and accountability. For that reason, I welcome the broad direction outlined in the White House’s “The Great Healthcare Plan,” which places transparency at the center of its reform agenda and frames it as the mechanism by which costs will fall, consumers will be empowered, and insurers will be held accountable.
These themes are familiar to anyone who has practiced medicine or paid for healthcare over the past two decades, and it is encouraging to see them articulated clearly. However, transparency without the infrastructure to operationalize it is not reform. Promising that patients will see better by talking about vision, without prescribing glasses, does not improve eyesight, and promising transparency without addressing the data, technology, and enforcement required to make it actionable does not improve healthcare cost and quality.
Lower prescription drug costs are necessary but still do not guarantee access
The plan’s focus on lowering prescription drug costs is both necessary and overdue, but it remains insufficient when separated from the realities of access and coverage. From firsthand clinical experience, I know that patients with chronic, vision-threatening diseases such as glaucoma are not losing their sight because effective medications do not exist, but because the structure of coverage makes those medications inaccessible.
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Copayments are frequently unaffordable, essential drugs are excluded from formularies, and out-of-pocket costs are structured in ways that force patients to make impossible choices between basic necessities and preserving vision. Lower list prices, while politically appealing, do not alter the insurer-controlled mechanisms that determine access, nor do they address adherence when benefit design continues to penalize patients for having chronic disease.
Moving medications toward over-the-counter (OTC) status may sound consumer-friendly, but for patients requiring ongoing monitoring, such an approach risks safety rather than improving outcomes. Drug pricing reform that does not directly address formulary design and insurer discretion treats affordability as a talking point rather than an access problem.
Maximizing price transparency without technology repeats a failed experiment
The plan’s emphasis on maximizing price transparency assumes that visibility alone will change behavior, yet the last fifteen years have already tested this assumption extensively. Multiple administrations, regulators, and pilot programs attempted to introduce transparency into healthcare pricing, only to discover that hospitals and insurers were unwilling to participate in ways that materially altered outcomes. Hospitals published chargemasters disconnected from negotiated rates and patient liability, insurers shielded pricing behind proprietary contracts and legal challenges, and when data was released, it was often so complex, fragmented, and context-free that it was unusable.
Transparency did not fail because the concept was flawed; it failed because the system lacked the technological infrastructure, standardized data models, and enforcement mechanisms required to make the information meaningful and fully pervasive. Publishing prices without integrating them into a platform that provides ubiquitous access is the equivalent of handing a patient an eye chart without glasses and calling it treatment.
Transparency requires data, technology, and AI—and someone must pay for it
What the plan does not address is what transparency actually requires to function in a system as complex as healthcare. Actionable transparency depends on interoperable data, standardized definitions, real-time analytics, and increasingly, artificial intelligence capable of translating raw information into decisions patients and employers can understand.
It also requires clarity on who builds this infrastructure, who governs it, and who pays for it. Transparency is not just policy, it is a technological undertaking. Without investment in data pipelines, integration across insurers and providers, and AI-driven tools that contextualize cost, quality, and outcomes, transparency remains theoretical. The plan speaks at length about disclosure, but says little about the operational backbone required to deliver it, or how those costs will be allocated across insurers, employers, providers, and government. Here transparency is important to the taxpayer.
Consumer cash without comprehension is still blind spending
The proposal to send money directly to consumers through savings accounts or similar mechanisms is framed as empowerment, but empowerment without comprehension is indistinguishable from abandonment.
Giving patients money without providing them with tools to interpret prices, assess quality, or understand risk is no better than sending them into a store blindfolded. Many patients lack the financial, medical, and statistical literacy required to navigate complex benefit designs and pricing structures, and expecting otherwise is unrealistic. Insurance premiums are lowered not through individual guesswork, but when self-insured employers, who fund the majority of healthcare in this country, hold insurers accountable and force competition. Cost-sharing across plans fails for the same reason transparency fails since there is no standardized, enforceable way to measure success. Eliminating PBM kickbacks and lobbying distortions is essential, but corruption removal alone does not create a functioning market.
Accountability requires leverage, not just disclosure
The plan’s approach to insurer accountability relies heavily on disclosure of loss ratios, claims denials, payouts, and wait times, yet disclosure without leverage has already proven ineffective. Insurers have already learned to game every published metric, including the medical loss ratios introduced under Obamacare, which became accounting exercises rather than consumer protections.
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When forced to stay under certain loss ratio thresholds, insurers merely gamed the system to reclassify costs.
No patient reading an insurer website understands what these ratios mean or how to act on them. Claims denial data is equally hollow, given the multitude of reasons denials occur, many outside the control of patients or physicians, and wait times reflect physician capacity and workforce shortages rather than insurer behavior.
True accountability has always come from entities with leverage—large employers and government—and yet the plan ignores employers, despite their central role as the actual payers.
What Obamacare taught us about promises without execution
This is not the first time transparency was presented as the solution to healthcare’s structural problems. Obamacare made similar promises, yet it took nearly sixteen years for many of its transparency proposals to fizzle. The failure was not accidental but reflected the complexity of implementation, resistance from entrenched stakeholders, and the absence of a technological and enforcement framework capable of delivering on those promises. The lesson is clear that announcing transparency is easy, operationalizing it is not, and without a concrete roadmap, timelines, and accountability, promises will ring hollow.
Why the plan fails the principles of “The Art of the Deal”
In “The Art of the Deal,” President Trump emphasizes leverage, incentives, and understanding who holds the cards in any negotiation. Successful deals are not built on goodwill alone, but on aligning interests and applying pressure where it matters. “The Great Healthcare Plan” does not fully reflect these principles. It asks insurers and hospitals to disclose information without fundamentally altering their incentives, offers consumers cash without bargaining power, and omits employers who possess the leverage necessary to enforce change. Negotiation without leverage is not negotiation, it is mere hope. A plan that does not recognize power dynamics cannot expect compliance, let alone transformation.
Transparency is a tool, not a treatment
The direction of “The Great Healthcare Plan” is not wrong. Transparency, lower drug prices and exposing middlemen all matter. But transparency without technology, data, and enforcement is not reform, it is just a plan. Just as improving vision requires lenses, not language, improving healthcare requires the infrastructure to translate information into action. Until transparency is paired with technology, AI-driven decision support, clear accountability, and an honest assessment of who pays and who benefits, the plan risks repeating the same cycle of promises that have defined healthcare reform for the past two decades. Good intentions are necessary, but without execution, they remain just that — intentions and sound bites.