Hospital costs can be reduced by splitting most hospitals 50/50 between two companies.
Medicaid costs can be reduced by gently nudging people away from the program, discouraging ER use and making nursing home care cheaper. Start with $2/month Medicaid premiums and raise them by $2 for each month and each ER use. The time-based Medicaid premium amount to not exceed the monthly Medicare premium.
Premiums to be lowered by $1 for each week you subsequently have PPACA-scope private coverage.
Nursing homes could be two side-by-side eight-bed units primarily staffed by four people, with one night staffer for each unit.
Medicaid reform could be tied to State And Local Tax (SALT) relief.
Drugs costs could be reduced by multi-government buying and payment voucher issue to patients at 80% of average drug class (biologic large volume, biologic small volume, etc.) Canadian maximum price in lieu of purchase. Let the patients wave the voucher at Walgreen’s and CVS. The drug companies will gladly take $500 for a monthly prescription that might cost them $100.
Trump said he wasn’t touching Social Security/Medicare/Medicaid. He promised lowering income taxes and implementing/raising tariffs.
That is what he ran on, and letting business CEOs set terms usually ends up poorly.
Reagan’s original across-the-board 25% income tax cut with indexing was great. The 1986 “tax simplification”, not so much.