Policy

Paying for care

Proposals for how American healthcare is paid for. I write these as a practicing neurosurgeon who has spent a career inside structured payment systems, and as someone who has spent nearly as long on open healthcare information systems. The standard I hold the proposals to is the one we apply to medical records: the rules should be clear, defensible, and open to inspection.

Policy proposal · November 2026 Working draft

A fair and coherent way to reduce drug prices

Medicare bluntly negotiates the drug prices for Part D and gives private plans a competitive domestic supply

Congress should establish universal prescription drug coverage on an expanded Medicare Part D framework, with national purchasing authority and an enforceable international price benchmark. Manufacturers that accept the benchmark keep their patents and gain predictable access to a large market. When a manufacturer refuses, the government could procure an approved equivalent from competing domestic suppliers, with compensation for the use of patented inventions. The paper sets out the coverage and financing, the price offer, the alternative-supply mechanism, and the fiscal test the legislation would have to pass.

Read the proposal Download (.docx)

Comments and corrections are welcome at jonathan@openhealth.org.