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He argued that reform of the delivery system is critical to getting costs under control, but that payment system reform (e.g., whether the government or private insurers process payments) is considerably less important yet gathers a disproportionate share of attention.Gawande argued that dramatic improvements and savings in the delivery system will take "at least a decade." He recommended changes that address the overutilization of healthcare; the refocusing of incentives on value rather than profits; and comparative analysis of the cost of treatment across various healthcare providers to identify best practices.According to a 2015 report from The Commonwealth Fund, although the United States pays almost twice as much per capita towards healthcare as other wealthy countries with universal healthcare, patient outcomes are poorer.

However, in the next election of Donald Trump as president, he campaigned to repeal and replace Obamacare and came up with a seven-point plan for healthcare reform.

With this seven point plan President Trump discussed that the healthcare system would work based on free market principles.

The healthcare reform debate in the United States has been a political issue focusing upon increasing medical coverage, decreasing costs, insurance reform, and the philosophy of its provision, funding, and government involvement.

Following the election of Barack Obama as president, who campaigned heavily on accomplishing health care reform, the Patient Protection and Affordable Care Act (PPACA) was enacted in March 2010.

Proponents of healthcare reforms involving expansion of government involvement to achieve universal healthcare argue that the need to provide profits to investors in a predominantly free market health system, and the additional administrative spending, tends to drive up costs, leading to more expensive provision.