Curing US Healthcare, Part III: The Future

Paul Krugman

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Curing US Healthcare, Part III: The Future<br>What reform could look like

Paul Krugman<br>May 24, 2026<br>∙ Paid

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The United States, uniquely among advanced nations, fails to guarantee healthcare to all its citizens. Partly as a result, it has worse health outcomes than comparable countries, including substantially lower life expectancy. Perversely, the U.S. delivers these poor results while spending much more per person on healthcare than anyone else.<br>U.S. healthcare performance improved in terms of both coverage and cost after the Affordable Care Act, aka Obamacare, was enacted in 2010 and went into full effect in 2014. But much of what was achieved during the Obama and Biden administrations is now being unraveled by Trump II.<br>Today’s primer is the third and final in a series. Part I laid out the basics of healthcare policy, why universal healthcare is a desirable objective, and why some type of government intervention is essential to achieve it. Part II described how and why the U.S. adopted Obamacare and the ongoing Republican assault on its successes. In today’s primer I will discuss a possible path forward. That is, basically, what Democrats can and should try to achieve if they have unified control of the government after the 2028 election.<br>Beyond the paywall I will address the following:<br>1. U.S. healthcare in international perspective<br>2. What kind of system is workable in America?<br>3. The changing political economy of American healthcare reform<br>4. The path forward

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