President-elect Donald Trump and his British counterpart, Prime Minister Keir Starmer, don’t agree on much. But on health care, the two men seem to share a common vision — a smaller role for government.
During the presidential campaign, Trump warned voters that Kamala Harris “wants everybody to be on government insurance” and vowed to make health coverage “better and less expensive.” Britons elevated the left-wing Labor Party to power earlier this year in part because of its promise to turn to the private sector to relieve pressure on the overburdened National Health Service.
Let’s start across the pond. The NHS is “broken,” in the words of Health Secretary Wes Streeting. In September, 6.3 million people were waiting for 7.6 million rounds of treatment. Roughly half have waited more than four months — some, more than a year. Waits for cancer treatment are at their worst level in 14 years. About 300 people died weekly last year due to NHS incapacity to provide accident and emergency care.
And yet, some Americans remain admirers of British health care. The most infamous might be Luigi Mangione, the alleged killer of United Healthcare CEO Brian Thompson. According to a British friend, Mangione had previously “expressed envy at the UK’s nationalized health system.”
The private sector can deliver coverage that’s cheaper, better, and more flexible.
Now, wonder of wonders, Labor is looking to the private sector as an emergency lifeline for procedures, scans, and appointments. Not since the 2008 financial crisis have so many in the U.K. sought refuge in private insurance as the public system struggles.
Meanwhile, in the United States, we’re suffering in the straitjacket of our own government-run healthcare bureaucracy. And like PM Starmer, President Trump has promised to fix it.
Most Americans receive health insurance coverage through their employers. For those who don’t, the Affordable Care Act — Obamacare — created government-run “exchanges” on which individuals can buy insurance.
Obamacare’s rules and regulations impose strict requirements on what plans must cover and how they can be priced. The twin results have been rapidly increasing premiums and restrictions on which providers patients can see.
As in his first term, Trump’s second-term health agenda will likely try to address this problem by focusing on a core challenge in American healthcare: About 5 percent of patients account for nearly half of health spending.
Before Obamacare, those who were already sick — that is, those with “pre-existing conditions” — found it difficult to obtain affordable health coverage. Insurers were leery of selling coverage to people who would pose high claims costs.
Obamacare tried to solve this problem by ordering insurers to sell coverage to everyone, barring plans from charging the old any more than three times what they charge the young, and counting on premiums from the young and healthy to cover the cost of those who were older and sicker.
In 2013, the year before Obamacare’s insurance regulations took effect, average individual monthly premiums were $244. By 2019, they were $558 — a 129 percent jump. Next year (2025), the average monthly benchmark premium is set to be $497. That’s an increase of 7 percent, on average, compared to 2024.
As premiums rise, Obamacare requires constant life support from taxpayers. Insurers receive hefty public subsidies to offset rising costs.
Trump allies have proposed creating separate “risk pools” to directly subsidize patients with pre-existing conditions. People at less health risk would be in their own risk pool — and could benefit from lower premiums that reflect their lower risk.
When Vice President-elect J.D. Vance first proposed fixing the risk pools in this way, critics claimed the sick and elderly would be penalized. But evidence from the first Trump administration suggests otherwise.
To encourage more innovation and experimentation in Obamacare, Trump gave states permission to split their risk pools. One governor who took advantage of the opportunity was none other than Democrat Tim Walz of Minnesota. As a result of the new risk distribution, premiums in Minnesota’s individual market dropped 20 percent — and nobody lost coverage.
During his first term, Trump also slashed needless red tape around short-term health plans, which are exempt from Obamacare’s cost-inflating rules, including its requirement that every policy cover ten essential health benefits. The change allowed Americans to enroll in short-term plans for up to one year — and permitted insurers to renew those plans for up to three.
The Biden administration reimposed stricter regulations on short-term plans earlier this year, capping coverage at a maximum of four months.
Reversing this federal intervention into private markets would help President Trump carry through on his promise to reduce costs for everyday Americans. On average, premiums for short-term plans are more affordable than comparable exchange plans. In some cases, they’re half as much.
Voters not only in America — but around the world — clearly think it’s time for the government to get out of the health insurance business. The private sector can deliver coverage that’s cheaper, better, and more flexible. We just have to let them.
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Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on X, formerly Twitter, @sallypipes.
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