Pillar 2: Healthcare Reform | The Great American Agreement

The Problem

Spending More, Getting Less

America spends over $4.7 trillion a year on healthcare — more per capita than any country in the world — but with outcomes that lag behind peer nations.

Millions remain uninsured or underinsured.
Small businesses struggle to offer affordable coverage.
Rural hospitals are collapsing while administrative costs soar.
Americans fear a single ER visit more than a car accident.

We have world-class providers trapped in a billing-first system. We have budgets large enough to protect our citizens — but misaligned incentives at every level.

We don't need to destroy the system. We need to direct it — jointly, intentionally, and at scale.

The Solution

Public-Private Healthcare Joint Ventures

Modeled after the defense sector, each Health JV is a regional partnership between:

The federal government
State or municipal governments
Existing non-profit and private health systems

These JVs are awarded fixed-cost contracts to deliver universal core services:

Preventative care
Emergency care
Maternal, pediatric, and chronic care management
Behavioral and mental health access

Profit is allowed — but only when the public mission is met.

How It's Funded

$2.2T

Existing public spend (Medicare, Medicaid, VA)

$267B

Tariff revenue (3× strategic expansion)

$402B

JV-driven efficiency savings (~10%)

Full coverage cost: $4.02T/year | Remaining gap: ~$1.15T

Political Positioning

A Structure Everyone Can Support

To the Right

Localized delivery, not federal takeover
Enables private-sector profit via mission delivery
Avoids income tax hikes — uses consumption-based contribution

To the Left

Universal coverage with access guarantees
Eliminates billing abuse and medical bankruptcy
Replaces profit-maximizing plans with outcomes-first delivery

To the Center

Cost-controlled, scalable, tested in parallel sectors
Doesn't require destroying private industry
Aligns private incentives with public good

Frequently Asked Questions

Addressing Concerns

Isn't this just Medicare for All?

No. It uses existing infrastructure + regional JVs. Care is public in purpose, but not single-payer in structure.

Will this eliminate private hospitals?

No. It integrates them — as service providers with guaranteed payment if they deliver core care.

How is this paid for without taxing everyone more?

Existing spend covers over half. We use strategic tariffs + cost savings. Remaining cost is bridgeable through JV structures.

Will this increase government size?

It increases government direction — not government labor. Administration is regionalized. Contracts are capped.

Why This Matters

We fund ships, satellites, and supply chains because we believe in national defense. We should fund care, coverage, and clinics the same way — as a public mission delivered through accountable partners.

Let healthcare become the next sector where Americans serve, invest, and build.