Our Darwinian Approach to Health Care Costs Author: Drew Altman Published: Jan 28, 2026

https://www.kff.org/from-drew-altman/our-darwinian-approach-to-health-care-costs/?utm_campaign=KFF-This-Week&utm_medium=email&_hsenc=p2ANqtz-_wP0R7p70P6mEbV0SG_if1jbaRahZnT2n6om9U9SDHzbnM4gQpN9GzMD7srJ01_oq_SkNH4uYxjGZGV7J7mKnsch3Oag&_hsmi=401271096&utm_content=401271096&utm_source=hs_email President Trump is now railing about insurance company premiums. The Ways and Means Committee and Energy and Commerce Health Subcommittee in the House just held hearings putting insurance company executives on the hot seat and examining a broad range of health cost issues. Politically, it’s an effort to shift accountability for affordability worries from Republicans to tried-and-true villains (insurance companies and drug companies), and blunt Democratic attacks to come in the midterms on affordability issues. It also helps to put health care costs back in the spotlight. What it doesn’t really do is put the costs that matter most in focus: spending for hospitals and doctors, which together represent 52% of the health care bill. With the exception of the occasional piece of legislation affecting them, such as site neutral payment for some hospital services, they have mostly been basking on the sidelines while drug companies (retail drugs are 9% of spending), and now insurance companies, take it on the chin.