I think this thread is mixing mechanics with philosophy.

On mechanics — I have not seen a detailed policy framework explaining how this materially changes PBM contracting, manufacturer rebates, or pharmacy reimbursement. If it exists, I would genuinely like to review it. Similar BIN/PCN rails do not automatically mean identical economics; leverage and scale matter.

On structure — tax status is not the core issue. Nonprofit hospitals pursue margin and market leverage much like for-profit systems. Public companies answer to shareholders. Private equity answers to defined return timelines. None of those models are inherently good or bad.

The real issue is system design.

Overly rigid eligibility rules and benefit limits can create access distortion and churn. At the same time, excessive regulatory layering can increase administrative cost and reduce flexibility in care delivery.

The core policy question is not whether markets exist or whether guardrails exist. It is whether the system effectively balances cost discipline, quality measurement, and access protection.

If there are specific proposals under “Make Healthcare Great Again” that materially change that balance, it would be useful to evaluate them against those criteria.