Can we make healthcare affordable?

On January 15, President Trump announced a “great healthcare plan” that seemed to have three components. It would formalize his push for pharmaceutical companies to lower their prices, send funds to individuals to help pay their insurance premiums and mandate price transparency for any hospital or other provider who participates in Medicare.

Will this do any good? Given the sparsity of details, analyzing this “plan” is analyzing air, but probably not much.

Going back to President Nixon, U.S. presidents have decried the high cost of medical care. In 1971 Nixon pronounced health costs as a crisis when healthcare consumed 7% of the Gross Domestic Product (GDP). In 1992 President Clinton said that “healthcare costs are increasing at unsustainable rates.”

Well, here we are in 2026, and healthcare now consumes 18% of the U.S. GDP, roughly double the cost in peer-countries.

In 2025, the average premium for a family plan was $26,993 - roughly 40% of the average worker’s salary. Even though much of this cost is borne by the employer (for those lucky enough to work for a company that offers health insurance), workers contributed an average of $6850 towards the cost.

Moreover, as insurance costs have skyrocketed, employers have tried to slow this by offering plans with high co-pays and deductibles, meaning that out-of-pocket costs have risen dramatically.

Keeping drug costs down is a start, but drug costs make up only 9-10% of healthcare spending.

When it costs $27,000, sending people $2000 to buy health insurance would not allow most lower income people to come anywhere near being able to afford it.

We have had mandated price transparency in law since 2021, and hospitals have proven very adept at making prices visible only to those with a PhD in computer science.

Yes, we MUST make healthcare affordable to all Americans, but this will require bold steps, with some pain for those currently getting rich off our dysfunctional, adminstration-burdened system, not “a concept of a plan.”


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The liver disease no one talks about

If you have diabetes, are overweight or have bad lipids, you may have MASLD: metabolic-associated steatotic liver disease – or fatty liver to be brief.

Most of us know that heavy alcohol use is bad for your liver, and years ago, most patients with cirrhosis (advanced liver damage with scarring and loss of function) were alcoholics.

In 2026, with the world-wide epidemic of overweight and obesity. MASLD has become the commonest cause of liver disease that can progress to cirrhosis. Up to 38% of adults have this! If you have Type 2 diabetes, that rises to 65%!

The first stage is fatty infiltration of the liver. If nothing is done, scarring and replacement of functioning liver tissue with fibrous (scar) tissue can follow. Eventually the liver loses much of its function, and the complications of a scarred non-functional liver ensue. These include jaundice, swelling of the legs and abdomen and bleeding.

Untreated MASLD is also the number one cause of liver cancer.

How can you prevent this cascade of catastrophes?

First, if you fit the risk profile (diabetic, overweight and/or high triglycerides), ask your doctor to check your liver. While most doctors know they should check your eyes if you have diabetes, many do not think about the liver.

Standard “liver function tests” are not routinely done and are not always abnormal in early stages of MASLD. While elevated liver enzymes may offer the first clue to the problem, 20-25% of people with biopsy-proven fatty livers have normal liver blood tests.

A better test is the “FIB-4” value, which is calculated from your age, two simple liver enzyme tests and the count of your blood platelets. If this is abnormal, an ultrasound test should be done to look for any scarring.

The good news is that getting your lipids and blood sugar under control and losing weight will reliably reduce fat in the liver and prevent you from going on to worse liver disease.

The GLP-1 drug semaglutide (Wegovy) has been proven to improve MASLD and is FDA-approved for this use. Though not studied for this use, the other GLP-1 agents would probably be equally effective.

You cannot live without your liver, so look after it!


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Who will care for me at home?

As birthrates fall and we live longer, western societies are aging. In the U.S., Canada and Britain, almost 20% of the population is over 65, while in Western Europe it ranges from 20 to 25%. Indeed, as baby boomers age, the fastest growing demographic is projected to be those 85+.

While today’s seniors are healthier than the elderly were a generation ago, aging eventually leads to the loss of some ability to live independently.

If an elder can no longer safely take a shower or grocery shop by themselves, what are their options?

As the last resort, moving to a nursing home is an option but, when asked, most seniors strongly prefer to age in their own home.

Besides being unappealing, nursing home care is expensive! In Massachusetts, a high cost of living state, the median cost of a semi-private room in a nursing home is $12,600 per month. Nationally, the median cost is $9555, which translates to $114,660 per year.

Staying at home instead of a nursing home means that help in the home will be needed. This can be provided by some combination of friends, family and paid caregivers.

Long-term, the U.S. must make policy decisions about how to cope with its aging population. In the immediate future, we need to provide more, and more affordable, help at home.

In 2024, some 3.2 million people worked as home health aides and personal care aides. To meet the demand, experts say that another 750,000 will be needed over the next decade.

Who are these people caring for our frail elders? Not surprisingly, almost 90% are women. About 30% are foreign-born, many from low-income countries such as the Dominican Republic, Jamaica, Haiti and the Philippines.

Home health workers are poorly paid, averaging $17/hour, and there is very high turnover. At the same time, the cost to care-recipients is high, averaging $34/hour. The difference is the money made by the agencies that employ the workers.

The agencies play a key role in vetting the home care workers. Given the possibility of physical abuse or theft by unknown individuals in the home of a dependent elder, hiring someone “off the street” is risky, yet keeping half of the cost seems excessive. If you or a loved one needs help at home, what are your options other than going through an agency?

The ideal option would be word of mouth. If a friend or neighbor has had a home aide that has been reliable, hiring them directly is an option. You can pay them more than they would get from an agency and still save money.

A better option would be for your state to set up a registry of vetted home health and personal care aides that individuals could access. The state could assume the responsibility for doing background checks and listing any complaints.

Massachusetts has such a registry, but it is only accessible to employers, not the public. Ask your state legislators to open the registry for public access.

The best fallback would be to call your local Visiting Nurse agency. They will either provide vetted home health aides or be able to direct you to a trusted local agency


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