Senate Finance Committee Democrats are seeking evidence and proposals to shape health-care legislation. Their critique of insurers has merit, but reforms confined to insurance risk leaving hospitals, conglomerates, and much of the system’s extraction untouched, sets the stage for further disappointment.
Access to affordable health care is now a hot button political issue. The popular fury at the system’s high costs, endless runarounds, and often less than stellar care is obvious. Not surprisingly, many Americans rank health care at or near the top of all their concerns as they evaluate candidates and political parties. Whether blueprints put forward for fixing the system would really work or not is thus a first order question.
On July 30, 2026, the Democrats of the Senate Finance Committee put forward an eighty-six page request for outside evidence and proposals that could become a basis for future legislation. They request responses by October 2.
We have collaborated intermittently for some years at the intersection of health care and political economy. We make no claim to being expert about all the American health care system’s many moving parts. But we have been studying it for a long time and trying deliberately to comprehend it as a system.
We credit Senate Finance Committee Democrats with producing the best discussion ever of how insurers profit by denying care — but they then propose a plan that misses two thirds to three quarters of the problem: roughly $382 billion a year, most of it hospital pricing. The insurance diagnosis is right and the Committee’s own numbers make a powerful case. But the reform proposals target insurers and little else, and a rule aimed at one company inside a conglomerate shuffles money to a sister company rather than saving it.
The Committee’s request for comments names itself the successor to an earlier committee’s “Call to Action” that preceded the Affordable Care Act. What it produces, therefore, is likely to serve as a foundation text for drafting new health care legislation in a future Congress. Whatever it omits likely stays omitted.
Beyond all the separate points our memorandum raises, accordingly, we thus recommend a twofold correction: Widen the legislation’s perimeter to reach hospitals and whole companies rather than simply their insurance affiliates; and adopt a definite measurable target — a five-percentage-point rise, within five years, in an audited share of every dollar that actually reaches care, counted across the parent and everything it owns. Extend the proposals that far and the Committee goes from inconveniencing a quarter of the money to recovering most of it for care.
* This INET Working Paper is issued simultaneously with Brainworks Ventures, though it represents the views of its authors only and not of any organization with which they are affiliated.
