Synopsis of “Grand Bargains”: Fixing Health Care and the Economy (Updated 2025)

Grand Bargains health system reform proposes a rapid, fundamental transition to a patient-centered, universal coverage system, largely government-funded (≥ 67% to 100% of costs), private “Accountable Care Cooperatives” (ACCs). This plan aims to replace the current fragmented landscape of multiple public and private insurance plans, shifting instead to private, member-owned, self-regulating ACCs. ACCs will compete for patients on quality of care and costs to patients. Government reimbursement of ACCs will be by average past cost of healthcare of patients and success in improving parameters of metabolic health (overweight, obesity, type 2 diabetes, hypertension (optimal average systolic blood pressure ≤120 mmHg), and abdominal girth (men ≤40 inches and women ≤ 35 inches).  

This new universal coverage would save taxpayers and patients $16 trillion over 10 years by freezing government healthcare funding at the 2026 level ($5.6 trillion annually) until 2035, reducing the projected US Federal Government deficit by 73.4% with this Grand Bargains scenario.  

The plan specifically targets inefficiencies stemming from:

1. Excessive Administration: Accounting for at least 30% of total healthcare costs, including public and private insurance-related expenses and administrative burden on healthcare providers.  

2. Unnecessary or harmful medical interventions: See my book, Money Driven Medicine—Tests and Treatments That Don’t Work.

3. Fraud: Estimated to range from 3% to 10% of total healthcare spending by the National Health Care Anti-Fraud Association.  

4. Overcharging: Evidenced by the significant difference between US per capita healthcare costs ($12,197 in 2021) and comparable countries' averages ($6,514).  

5. Higher Salaries and Wages: Physician wages are approximately twice as much as in comparable countries. Nurses receive about 1.5 as much as in other countries.  

6. Health Employment: The US employs 64 people per 1,000 population in health, slightly below the comparator country average of 70 per 1,000. By reducing the above excessive administration, salary and wages for physicians and nurses, prescription drugs etc., the number of actual healthcare providers could be at least increased by one-third.  

7. Prescription Drugs: Representing about 10% of spending, with the US spending twice as much per person than in other developed countries.  

8. Medical Price Gouging: Resulting from a lack of price competition and the insulation of insured patients from price considerations.  

9. Ineffective Pricing Mechanisms: "Reference pricing" has demonstrated the potential to reduce medical procedure costs by 10-20%. Reference pricing is a strategy used by payers (like employers or health insurers) to set a maximum amount they will pay for a specific medical procedure, service, or pharmaceutical,  

10. Fund and employ strategies to improve metabolic health: Focus on diet, exercise, stress management to prevent metabolic diseases (overweight, obesity, high blood pressure, type 2 diabetes, and large abdominal girth).  

11. Better Healthcare for Children: Bring health enhancement strategies to all US children, led by pediatricians and school educators to enhance options for addressing metabolic health and mental health challenges.  

1. Decentralizing clinical practice regulation.

2. Giving patients and providers choices of Accountable Care Cooperatives.

3. Requiring transparency from ACCs.

4. Fostering competition in price and quality among ACCs.

5. Freezing government healthcare funding at the 2026 level until 2035.

While acknowledging that national health expenditures could still rise if too many individuals choose ACCs with increased premiums or if Congress increases government funding above the 2026 level, the "Grand Bargains" plan posits that this approach would return control of healthcare choices to individuals and cost control to policymakers, potentially reducing national health expenditures to 12.4% of projected 2035 GDP if costs are successfully maintained at the 2026 level. The status quo healthcare spending estimates for 2035 ($9 Trillion) and the US GDP estimate for 2035 ($44.8 Trillion) gives 20.1% as the projected healthcare portion of the 2035 US GDP. With a recession or pandemic in the next 10 years, healthcare spending could be proportionally much higher.

Excel spreadsheet link.