The truth about affordability, because that’s the tired drumbeat the Left will pound all the way into 2026: “prices are high, blame the billionaire.” It’s the same old class-war script—paint the rich guy as out of touch, pretend the pain at the pump and the grocery store fell from the sky, and hope voters forget who built the scaffolding for that pain. The truth is, affordability has roots—deep, structural roots—in policy choices that take years to unwind. Unwinding is slow; rebuilding competitive markets is slower; letting innovation breathe is slower still. But it happens. And when it happens—especially around energy and health care—you feel it first in the path of prices, then in the path of opportunity. That’s the meat and potatoes of the issue that everyone needs to understand as we go forward.
Starting with health care because it’s so grotesquely obvious—the Democrats’ favorite talking point and, paradoxically, their favorite controlled market. What the public senses as “expensive care” is really an industry whose cost structure is defended by regulation, protected monopolies, and financial engineering that prioritizes jobs and margin over cures. Just look at the macro: national health expenditures reached roughly $4.9 trillion in 2023—17.6% of GDP—and blew past $5 trillion in 2024, with CMS projecting the health share of the economy could hit 20.3% by 2033. That’s not me speculating; it’s the official actuaries. They estimate spending growth of 8.2% in 2024 and 7.1% in 2025—outpacing GDP—driven by rising utilization and coverage levels. 1234 You don’t need a PhD in economics to hear what that says: health care, as currently constituted, is set on an upward cost glide path that eats the economy.
Dig beneath the top line, and you find what patients feel: hospitals posted double-digit spending growth in 2023; physician services accelerated; prescription drugs jumped more than 11% in 2023 alone. 1 These are not isolated blips—they’re part of a financing machine that has learned to monetize chronic decline. It’s the difference between maintaining weakness for revenue and making patients truly well, which would shrink the revenue base. That philosophical choice drives both policy and practice.
Layer in the private‑equity wave. In health care, PE ownership has expanded rapidly across hospitals, specialty practices, nursing homes, and ancillaries. Systematic reviews in BMJ and updates from Wharton’s HMPI synthesize dozens of empirical studies and repeatedly find what clinicians and patients suspect: PE ownership is most consistently associated with higher costs to patients or payers and mixed-to-harmful impacts on quality. Staffing skews downward, administrative pressure increases, and the exit horizon is 3–7 years, with debt piled onto the acquired entity. 56 Even JAMA’s coverage of the evidence lands in the same place: higher costs, quality concerns. 7 Now, to be fair, not every PE hospital outcome is catastrophic; a late‑2025 research brief found no excess closures and cost-cutting concentrated in admin rather than core medicine, though patient satisfaction dipped. 8 But the through‑line is unmistakable: financialization has bridged into care delivery, and the pass-through is inflationary for payers and patients. When you lace debt service, management fees, and rapid roll-up incentives on top of already rising unit costs, affordability dies by a thousand cuts.
And we haven’t even touched the bigger affordability architecture—consolidation and financialization across supply chains. Ten years ago, lean shops squeezed costs by owning their processes and competing in open markets. Today, in many sectors—manufacturing, food processing, distribution—the playbook is add-on acquisitions, platform roll-ups, and fee-driven intermediaries. Private equity has poured roughly $262 billion into U.S. manufacturing firms since 2020, explicitly to consolidate and “unlock value at speed,” while debt financing has been layered into an already fragile logistics environment. 910 The National Economic Council’s 2021–2024 Quadrennial Supply Chain Review lays it out in sober terms: critical chains—from energy components to pharmaceuticals and agri‑food—were brittle, policy‑distorted, and subject to non-market practices that amplified shocks. 11
Why should voters care about that alphabet soup of capital and supply chain policy? Because the price on your shelf has a genealogy. COVID made that visible; economists at Brookings argue that the inflation shock was largely supply-driven, with long lags as delivery times normalized and margins reset—proving that what breaks upstream ripples downstream for years. 12 The Richmond Fed estimates that about half of a disruption’s total effect comes from amplification through the supply network; shocks abroad propagate into U.S. GDP and inflation, and re-shoring, redundancy, and inventory carry real cost. 13 Translation: if you replace diversified mom‑and‑pop networks with concentrated platforms, then hit those platforms with a once-in-a-century shock and policy friction, you get sticker shock that doesn’t vanish overnight.
Then there are the minimum wage mandates, which I warned about a decade ago when Democrats pushed for them and which, mainly, got what they wanted during Covid—the bottom-up piece of the affordability puzzle. The Left sells them as “free money,” then acts surprised when menus and price tags jump. The CPI tells a straightforward story: food away from home rose 3.6% in 2024, outpacing grocery inflation, and industry groups show menu prices still rising into late 2025. 1415 CNBC put a fine point on limited-service meals: almost 28% price growth from 2019 to 2023—well above the overall CPI—driven in part by labor cost increases that chains passed on to customers, especially in high-mandate states. 16 The academic literature fills in the mechanism. Recent meta-analysis estimates a 0.03–0.11 price elasticity to minimum wage changes—meaning a 10% hike produces roughly 0.3–1.1% price increases, bigger in labor-intensive sectors like restaurants. 17 NBER and Upjohn surveys show mixed employment effects but clear evidence of slower job growth and hours adjustments over time, with price pass-through in narrow industries. 1819 And when wage floors leap in gig delivery, the “unintended consequences” are no longer theoretical; a 2025 NBER working paper tracking Seattle’s 2024 ordinance found base pay doubled per task, but tips and order volume fell, netting out the gains for most active drivers within a month while delivery costs popped and idle time rose. 20 All that flows straight into the affordability experience at the counter. If your value meal used to be $5 and now feels like $10, it’s not imaginary—the chain is absorbing higher mandated labor costs, higher input volatility, and a consolidated middleman layer that taxes every step. The macro data confirm the sting: food prices rose 2.5% overall in 2024, but restaurant inflation was higher, and eggs, beef, and insurance were outliers. 14
The other pillar in the affordability conversation is energy—because it feeds trucks, ships, harvesters, ovens, and heat. Here’s some good news: U.S. oil production set records through 2024 and 2025, with the EIA projecting record crude and gas output in 2025, and AAA reports December 2025 gasoline averages around $2.89 nationally—the cheapest December since 2020. That’s not partisan; that’s a supply reality. 212223 The EIA’s Short‑Term Energy Outlook expects Brent to settle near $55/bbl through 2026 as inventories rise, while dry gas production continues climbing. 24 In plain English: drilling and efficiency gains—especially in the Permian—have kept domestic supply high and prices stable, muting one of the biggest drivers of household pain. 25 So when we say a pro‑production posture affects affordability, this is the line we draw: more barrels and cubic feet, fewer spikes at the pump, cheaper freight, easier input cost for food and goods.
Affordability isn’t “high versus low prices in a vacuum.” It’s the architecture of how costs stack up: energy feeds logistics; logistics feed input prices; input prices feed menus and store shelves; health care premiums drain the checking account regardless. If your cost stack is built on regulated scarcity, consolidated intermediaries, debt‑service layers, and mandated wage floors, you’ve engineered inflation. If you reverse the stack—by increasing supply (energy), rebuilding distributed ownership (manufacturing and ag), and unleashing cures (health)—you engineer disinflation. And yes, it has a lag because capital redeployments and networks re-route over quarters, not weeks.
Now, about health care’s future—the part that sounds disruptive because it is. The frontier is not the following billing code; it’s gene editing, cellular regeneration, and targeted micro‑devices that fix the plumbing without cracking open the chest. CRISPR-based therapies have already crossed the FDA threshold for specific indications, signaling that programmable biology isn’t science fiction anymore, though current price points are eye-watering and regulatory guardrails are tight. 26 Stem cell advances proceed unevenly under FDA frameworks, but the pipeline is real, and the durability of regenerative approaches changes the calculus on chronic disease costs. 27 As for “nanobots in arteries,” let’s be scientifically precise: at present, that’s experimental vision—nanotechnology for targeted delivery and plaque management is under research, but widespread, approved deployment in the U.S. is still a few years away, as in 2030. The trajectory, however, is toward minimally invasive, programmable interventions that obviate today’s expensive, labor-intensive procedures. If you strip the hype and ask, “What happens to costs if cures replace maintenance?” the answer is radical deflation in medical services that today require giant physical plants, armies of staff, and recurring billing. The only things stopping acceleration are policy acceptance and risk-tolerant frameworks that protect patients while allowing innovation to scale.
That leads to the tricky question: do we design a system that keeps people sick slowly—so the machine gets paid—or do we create a system that heals fast, and then reallocates labor to growth sectors like space, advanced manufacturing, and AI-enabled industrials? We can’t flip that switch in two months. If you liberated regenerative and gene therapies tomorrow without adjusting reimbursement and licensure, you’d displace millions of jobs and crash legacy revenue streams. But over a decade, with clear lanes for innovation and targeted transition support, you can migrate human capital to sectors that compound prosperity—what I call the “space economy” and adjacent fields—so people live longer, healthier lives and earn across extended productive spans. Morgan Stanley and others project trillion-dollar trajectories in space-enabled services, manufacturing, and communications; the point isn’t the exact number, it’s the labor shift: from managing decline to building frontiers. 28
Affordability also lives in the home. Property taxes are the most visible local lever, and they’ve been creeping up. ATTOM’s national analysis finds the average single-family property tax bill rose about 5–6% in 2024 to roughly $4,300, while effective rates ticked slightly down as home values rebounded. The press summary in early 2025 pegged average bills around $4,172 and highlighted regional variance, with Northeast/Midwest rates higher. Different methodologies, same lived experience: homeowners feel the pinch. 2930 AAA talks about gas as one side of the ledger; property taxes are the other, especially in school-heavy budgets. The Lincoln Institute’s state-by-state comparison shows effective rates are a function of reliance on property tax, home values, and spending levels, with Detroit at the high end and Honolulu at the low end for homestead effective rates. Assessment limits can shift burdens onto new buyers—a silent affordability killer. 31 Economists even argue that higher property taxes can—counterintuitively—reduce entry prices and reallocate homeownership toward younger families by capitalizing the tax burden into lower upfront costs, though that shifts pain onto older and low-income owners. 32 My point isn’t that one tax tweak fixes affordability; it’s that you can’t jack up wages, ignore supply, and raise local levies without squeezing families from three directions. If wages must rise for entry-level dignity, then energy, health, and taxes must fall—or the squeeze is intolerable. That’s arithmetic.
Ask yourself: who broke the affordability architecture? Food-at-home inflation cooled in 2024—USDA pegs it at around 1.2%—because some inputs normalized after supply shocks, yet restaurants remained pricier because labor and overhead didn’t normalize. Eggs spiked again on disease resurgence; beef rose on low cattle inventories. 33 Meanwhile, gasoline trended down year‑over‑year into late 2025; the national average sat below $3 by December. 2223 None of that aligns with the “blame the billionaire” slogan. It aligns with policy levers: energy supply, wage mandates, consolidation rules, and the health care financing model.
So when critics sneer, “What does a billionaire know about affordability?” the answer is: affordability isn’t about your bank account, it’s about whether you understand the machine. In 2017-2019, we saw what pro-production energy, plus regulatory breathing room, can do—pump prices stabilized, and freight costs fell. In 2024‑2026, EIA projections show strong domestic output and soft global prices—potential tailwinds if you don’t throttle drilling or overregulate pipelines. 2124 In the next three to five years, health innovation could begin to bend the cost curve—but only if you let it. And over the same window, you can chip away at consolidation by encouraging distributed ownership, limiting fee extraction, and restoring competitive procurement in sectors like aerospace and ag.
Agriculture is instructive. USDA reports 1.89 million farms in 2023—down slightly—with land in farms also down and acreage concentrating in high‑sales classes. In 2023, farms with $500,000+ in sales operated roughly half of all farmland—a consolidation pattern built over decades. 34 ERS’s historical work shows crop acreage shifting persistently toward larger operations; livestock consolidation has been episodic but dramatic in some lines. 3536 Production expenditures climbed to about $482 billion in 2023, with feed, labor, and services dominating the cost share. 37 That’s not a mom-and-pop landscape; it’s an industrial farm economy whose cost base moves with energy, labor, and finance. If you push mandates and taxes up while tolerating monopolized inputs, you get $6 milk and $10 burgers.
Affordability doesn’t fix itself in a quarter. It takes enthusiasm and patience—years, not months. In a MAGA-style agenda, you’d do three things at once: push energy to keep gasoline, diesel, and electricity stable; open lanes for regenerative medicine and gene therapy with reimbursement and safety frameworks that accelerate cures; and de-financialize chokepoints in supply chains by favoring private ownership, competition, and transparency over fee-stacked intermediaries. The lag effect is real. CMS projects health’s share of GDP rising, not falling, through 2033 under current assumptions; turning that curve requires more than rhetoric. 38 But you can feel affordability improve in the interim if energy and freight stay tame and food inflation stays cooled—as the 2024 numbers did. 1433
The choice at the center of health care affordability, because it’s moral as much as economic: do we maintain people’s weaknesses to preserve a sprawling, union-protected, fee-protected medical services empire, or do we make them strong again—knowing we must redeploy those workers into frontier industries? If you want the second outcome, embrace innovation and plan the transition. The space economy, industrials, AI-enabled maintenance, precision manufacturing—those aren’t sci-fi; they’re labor sinks ready to absorb talent. 28 You don’t solve affordability by berating billionaires; you solve it by designing an economy that doesn’t require families to hemorrhage cash for energy, food, and maintenance of decline.
Today’s gas is under $3 in many regions. 22 Food-at-home inflation cooled to near 1%. 33 Health spending is still climbing because we feed the maintenance machine. 1 Minimum wage hikes push menus higher, especially in limited‑service. 1617 Consolidation and financialization tax every step of the supply chain. 1110 Property taxes squeeze homeowners even as effective rates wobble with valuation cycles. 29 If you want affordability, you have to unwind the stack that made it scarce—and that takes leadership, authentic leadership that is very hard to get and takes a lot of guts to utilize.
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Footnotes
1. National health expenditures and projections: CMS NHE Fact Sheet and analyses indicate $4.9T in 2023 (17.6% GDP); projected 8.2% spending growth in 2024 and continued gains through 2033 to ~20.3% of GDP. 123
2. 2023 component growth: hospital (+10.4%), physician services (+7.4%), prescription drugs (+11.4%). 1
3. PE in health care—cost and quality impacts: BMJ systematic review (2023); HMPI update (2024); JAMA coverage (2023). 567
4. PE hospitals: no excess closures; admin cost cuts; patient satisfaction decline. 8
5. Supply-driven inflation and lagged normalization: Brookings commentary (2024). 12
6. Supply chain shock amplification: Richmond Fed Economic Brief (2025). 13
7. Restaurant price dynamics: BLS CPI (2024 review); National Restaurant Association menu price notes (2025). 1415
8. Limited‑service price increases vs CPI: CNBC analysis (2019–2023). 16
9. Price pass-through elasticities from minimum wage hikes: meta-analysis (2025). 17
10. Seattle gig delivery minimum wage outcomes (2024–2025): NBER working paper coverage. 20
11. Energy production and prices: EIA STEO (Dec 2025), projections of record crude/gas; AAA national average ~$2.89 in Dec 2025; EIA weekly regional gasoline data. 24212223
12. U.S. oil production highs in 2025 (EIA/Reuters round-ups). 25
13. CRISPR therapy approvals and trajectory: FDA‑tracked approvals in 2023–2024; cost and regulation context. 26
14. Stem cell therapy/regulatory status: overviews and policy context. 27
15. Space economy outlooks and manufacturing metrics: NIST manufacturing report (2024) for macro context; industry projections. 28
16. Property tax trends: ATTOM 2024 analysis; Mortgage Professional America summary (2025); Lincoln Institute 50-state comparison; Minneapolis Fed analysis on property taxes and home prices. 29303132
17. Agriculture consolidation and expenditure trends: USDA NASS Farms and Land in Farms (2023); ERS “Three Decades of Consolidation”; AEI policy slides; NASS production expenditures (2023). 34353637
18. Food‑at‑home inflation easing in 2024; category specifics and 2025 outlook: USDA ERS Charts of Note. 33
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Bibliography & Further Reading
• Centers for Medicare & Medicaid Services (CMS). “NHE Fact Sheet.” 1
• American Hospital Association summary of CMS projections (June 2025). 2
• Peter G. Peterson Foundation on health share of GDP. 3
• American Medical Association Policy Research Perspectives on NHE 2023. 4
• BMJ (2023). “Evaluating trends in private equity ownership…” 5
• HMPI (2024). “Update on impacts of PE ownership in health care.” 6
• JAMA (2023). “Private Equity Ownership in Health Care Linked to Higher Costs…” 7
• Cato Institute (2025). “Private Equity in the Hospital Industry.” 8
• Brookings (2024). “Lagged effects of COVID-19 supply chain disruptions.” 12
• Federal Reserve Bank of Richmond (2025). “Supply Chain Resilience and Shocks.” 13
• BLS. “Consumer Price Index: 2024 in review.” 14
• National Restaurant Association. “Menu Prices,” Dec 2025. 15
• CNBC (2024). “Why fast-food price increases have surpassed overall inflation.” 16
• NBER Working Paper (2024/2025 meta & surveys). 1839
• Jorge Pérez Pérez (2025). Meta-analysis on minimum wage and prices. 17
• Reason (summarizing NBER Seattle delivery study) (2025). 20
• EIA Short‑Term Energy Outlook (Dec 2025). 24
• Offshore Technology (Mar 2025). “EIA forecasts record US crude and gas production…” 21
• AAA Fuel Prices Newsroom (Dec 2025). 40
• EIA Gasoline & Diesel Update (Dec 2025). 23
• Pipeline & Gas Journal (Aug 2025). “U.S. Oil Production Hit Record High in June.” 25
• FDA-related coverage and analyses of CRISPR therapies (2023–2024). 26
• Health journalism on stem cell regulatory landscape (2025). 27
• NIST (2024). “Annual Report on the U.S. Manufacturing Economy.” 28
• ATTOM (Apr/Jul 2025). “2024 Property Tax Analysis.” 29
• Mortgage Professional America (Apr 2025). “US property tax bill jumped again in 2024.” 30
• Lincoln Institute (Jul 2025). “50-State Property Tax Comparison Study.” 31
• Minneapolis Fed (Nov 2024). “How higher property taxes increase home affordability.” 32
• USDA NASS (Feb/Jul 2024). Farms and Land in Farms; Production Expenditures. 3437
• USDA ERS (2018). “Three Decades of Consolidation in U.S. Agriculture.” 35
• AEI (Feb 2023). “Farm Consolidation: Three Implications for Farm Policy.” 36
• USDA ERS (Jan 2025). “Retail food price inflation subsided across most categories in 2024.” 33
Rich Hoffman
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