Healthcare is one of the major concerns of the American public. It has emerged as a major component of the affordability challenge in the 2026 election, at a time when 85% of the public agrees that the healthcare system needs major structural change. In this issue, we report a new national analysis of how these views are translated into the campaigns of political candidates for House, Senate and Gubernatorial races in the midterm elections.
The ability to collect these data from individual campaign websites has advanced greatly with the advent of AI and AI agents. These data are fascinating in what the candidates find as compelling issues, and as fascinating for what is missing.
The study reviewed 972. The authors found that reproductive health and abortion access was mentioned on 53% of sites, followed by 44% for Medicare, 41% for mental health, and 40% for prescription drug pricing. Only half of sites (51% overall, 73% Democratic, and 28% Republican) mentioned any of the six issues that the authors suggest explicitly concern affordability (drug pricing, insurance premiums, hospital prices and price transparency, surprise billing, medical debt and health care costs in general). Even when these affordability issues were mentioned, the most common message was about drug pricing. Excluding drug pricing, only 33% of sites (43% of Democratic and 22% of Republican) mentioned any of the remaining five affordability issues.
What is missing from the campaign websites is a set of policy ideas that can tackle the top issues identified by voters: affordability and health system structure. Medicare for All is really the only concept that addressed systematic reform of the healthcare system, and this concept has been extensively litigated at the federal and state level. Not only is there concern about the structure of such a program, but there are significant concerns about the financing of such a program, and, as importantly, the capacity for the government to implement and manage such a massive program. The National Health Service in the UK, a potential model of such a system, is in perpetual crisis addressing the needs of a rapidly aging population with limited resources. Of course, creating the fiscal space for an expansion of Federal healthcare spending will be extremely challenging with a $2 trillion deficit.
The dearth of policy ideas to tackle persistent problems such as those confronting healthcare is starting to achieve recognition by the broader policy community.
At Stanford, we are trying to address this gap. We have initiated the RUSH Project-Re-Platform US Healthcare, to tackle seven underlying problems in the healthcare system: primary care, provider productivity, financing structure, administrative costs, rural healthcare, healthcare governance, and healthcare communications. This project is based on the methodology of “Precedents Thinking,” developing a systematic search for firms and markets elsewhere that have tackled some or all these core challenges. An effort to use this approach to address the massive administrative costs of the healthcare system was featured in a previous issue of HMPI.
It is beyond time for the health policy community to develop and offer real solutions to the problems of healthcare to the American public. Let’s hope that a repeat survey of the candidate platforms for 2028 offers more actionable choices to the public desperate for help.
[3] Brooke Istvan, Perry Nielsen Jr, Megan Eluhu, Bryan Kozin, Walt Winslow, David Scheinker, Kavita Patel, Kenneth Favaro, Stefanos Zenios, Kevin Schulman. 2024. Applying Precedents Thinking to the Intractable Problem of Transaction Costs in Healthcare. Health Management, Policy and Innovation (HMPI.org). Volume 9, Issue 3.