In announcing its “Great Healthcare Plan” in January 2026, the Trump administration became the latest in a long history of efforts by the U.S. government to rein in the soaring cost of health care.

As a physician and professor studying the intersection of business and health, I know that the challenges in reforming the sprawling U.S. health care system are immense. That’s partly for political and even philosophical reasons.

But it also reflects a complex system fraught with competing interests – and the fact that patients, hospitals, health insurance companies and drug manufacturers change their behaviors in conflicting ways when faced with new rules.

U.S. health care is the most expensive in the world, and according to a poll published in late January 2026, two-thirds of Americans are very worried about their ability to pay for it – whether it’s their medications, a doctor’s visit, health insurance or an unpredictably costly medical emergency.

Disputes over health policy even played a central role in the federal government shutdown in fall 2025.

Trump’s health care framework outlines no specific policy actions, but it does establish priorities to address a number of longtime concerns, including prescription drug costs, price transparency, lowering insurance premiums and making health insurance companies generally more accountable.

Why have these challenges been so difficult to address?

Prescription drug costs in the U.S. began rising sharply in the 1980s, when drugmakers increased the development of innovative new treatments for common diseases. But efforts to combat this trend have resembled a game of whack-a-mole because the factors driving it are so intertwined.

One issue is the unique set of challenges that define drug development. As with any consumer good, manufacturers price prescription drugs to cover costs and earn profits. Drug manufacturing, however, involves an expensive and time-consuming development process with a high risk of failure.

Patent protection is another issue. Drug patents last 20 years, but completing costly trials necessary for regulatory approval takes up much of that period, reducing the time........

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