Note: The following article is sponsored by Americans for Limited Government and penned by Robert Romano, the organization’s executive director.

For years, Washington has vowed to reform health care, yet the reality has been a surge in costs, increased bureaucracy, and a complex network of intermediaries profiting at patients’ expense. Unlike seasoned politicians such as Joe Biden and Kamala Harris, President Trump is taking action to eliminate these intermediaries, empowering patients in the process.

The cornerstone of Trump’s initiative is the promotion of direct-to-consumer health care models, like Trump Rx. This approach bypasses the need for patients to seek approval from insurers, Pharmacy Benefit Managers (PBMs), and bureaucrats. Instead, it offers patients the opportunity to obtain medications directly from manufacturers, with clear pricing and minimal intermediary interference. It’s a straightforward, user-friendly solution that many view as long overdue.

The true obstacles in the health care system are not the doctors or pharmaceutical companies, but rather the intermediaries. PBMs, who operate between patients, pharmacies, insurers, and manufacturers, have been exploiting the system for their own benefit. Their business model thrives on inflated list prices, substantial rebates, and increased complexity, leading to patient losses and PBM gains.

President Trump is determined to dismantle this flawed system.

In a significant move, Trump has signed legislation aimed at curbing PBM payment practices by decoupling their compensation from drug list prices. This change is crucial because PBMs have historically profited from higher list prices, often guiding insurance plans towards costly drugs regardless of cheaper, equally effective alternatives. By breaking this connection, Trump is challenging the distorted incentives that have historically driven up health care costs for Americans.

This is not abstract policy talk. It’s a direct assault on a rigged system.

And the effort doesn’t stop there. Under Trump’s leadership, the Federal Trade Commission has refocused on protecting consumers instead of appeasing corporate gatekeepers. With Chairman Andrew Ferguson serving as enforcer of healthcare competition, the FTC is moving aggressively to rein in PBM abuses that distort competition and inflate costs.

That includes actions to stop dominant PBMs like Express Scripts from gaming formularies — preferring high-priced drugs over lower-cost equivalents simply because the rebates are bigger. When PBMs use their market power to block competition and pad profits, that’s not a free market. That’s cartel behavior, and Trump’s FTC is treating it that way.

Predictably, the swamp is furious.

PBMs and their allies warn that reform will “disrupt the system.” Translation: it will disrupt their revenue stream. They’ve spent years hiding behind complexity, hoping Americans wouldn’t notice who’s really driving up costs at the pharmacy counter. Trump noticed — and he acted.

This is what America First health care looks like. Fewer middlemen. More transparency. Real competition. Patients in control.

While Democrats stand with their Big Insurance political donors, Trump is doing what he’s always done: challenging entrenched interests and siding with everyday Americans. Whether it’s negotiating better trade deals, exposing middlemen markup schemes, or empowering consumers through direct access, the goal is the same — lower costs and better care.

Health care doesn’t need more Washington “experts.” It needs a wrecking ball aimed squarely at the middlemen who broke it in the first place. Trump promised to take a swing — and he is. Americans are better off for it.