Paul Ryan Champions Health Care Policy Reform, AI Amid Government Shutdown – The American Journal of Managed Care® (AJMC®)

Report on Policy and Innovation for a Sustainable Healthcare System

A report on the address by former Speaker of the House, Paul Ryan, at the Academy of Managed Care Pharmacy (AMCP) Nexus 2025, focusing on policy, innovation, and their alignment with the United Nations Sustainable Development Goals (SDGs).

1.0 Strengthening Institutions and Policy for Health and Well-being (SDG 3, SDG 16)

The discussion highlighted the critical need for a stable and predictable policy landscape to achieve SDG 3 (Good Health and Well-being). Current political polarization and reliance on executive orders undermine the development of a sustainable healthcare framework. To foster SDG 16 (Peace, Justice, and Strong Institutions), the following points were emphasized:

• Legislative Clarity: Congress must draft precise and unambiguous laws to limit executive overreach and ensure stable, long-term health policies. Vague legislation cedes excessive power to the executive branch, creating an unpredictable environment for healthcare providers and patients.
• Institutional Integrity: Maintaining the distinct roles of the legislative and executive branches is fundamental for effective governance. Political gridlock has impeded Congress’s ability to legislate, leading to a dependency on executive actions that can be easily reversed.
• Stakeholder Engagement: To ensure policies are effective and equitable, healthcare professionals and associations must actively engage with policymakers. This participatory approach is essential for creating informed legislation that reflects real-world consequences and supports the goal of universal health coverage.

2.0 Economic Sustainability and Social Protection in Healthcare (SDG 8, SDG 10)

The long-term fiscal viability of America’s social contract, including Medicare and Social Security, was identified as a primary challenge. Demographic shifts, with fewer workers supporting a growing number of retirees, threaten the system’s sustainability, impacting SDG 8 (Decent Work and Economic Growth) and SDG 10 (Reduced Inequalities).

2.1 Proposed Reforms for Fiscal Health

1. Modernize Medicare: Transition to a patient-centered, competition-based model, such as a premium support system. This would provide seniors with choices among competing health plans and offer subsidies adjusted for health status and income, promoting both efficiency and equity.
2. Enhance Social Program Solvency: Adjust the retirement age by linking it to modern longevity data. This would encourage longer work lives, strengthening the taxpayer base and ensuring the financial health of entitlement programs for future generations.
3. Address Medicaid Reimbursements: Policy changes affecting Medicaid reimbursements, particularly those targeting specific demographics, require careful consideration to avoid exacerbating inequalities and ensure continued access to care for vulnerable populations.

3.0 Leveraging Innovation for Universal Health Access (SDG 3, SDG 9)

Achieving universal access to affordable, high-quality healthcare requires balancing the high cost of innovation with the need for broad patient access, a core tenet of SDG 3. This involves fostering an environment that supports SDG 9 (Industry, Innovation, and Infrastructure).

3.1 Strategies for Innovation and Access

• High-Cost Patient Solutions: Implement state-based, federally financed risk pools to manage the costs of medically complex patients. This strategy would concentrate resources on those with the greatest need, making insurance more affordable for the broader population and ensuring access to innovative treatments like cell and gene therapies.
• Artificial Intelligence (AI) Integration: Embrace AI as a transformative tool to improve healthcare efficiency, reduce costs, and enhance patient outcomes. AI has the potential to solve significant demographic and budgetary challenges, accelerating progress toward affordable, universal care.
• Promoting Technological Leadership: The United States should lead in AI development and establish global standards. Proactive, rather than restrictive, regulation will secure a first-mover advantage, ensuring that AI is shaped by democratic values to benefit global health.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article discusses issues related to healthcare policy, sustainability, innovation, and governance in the United States. Based on this, the following Sustainable Development Goals (SDGs) are addressed:

• SDG 3: Good Health and Well-being: The core of the article revolves around building a “sustainable and effective health care system.” It addresses the affordability of care, access to innovative treatments, and the financial sustainability of public health programs like Medicare and Medicaid. Paul Ryan’s proposals aim to ensure long-term health and well-being for the population, particularly seniors.
• SDG 9: Industry, Innovation, and Infrastructure: The article strongly emphasizes the role of “technological innovation” in solving healthcare challenges. Ryan’s advocacy for Artificial Intelligence (AI) as a “critical solution” to improve efficiency, lower costs, and enhance care directly aligns with fostering innovation. The discussion on incentivizing pharmaceutical development for new treatments like cell and gene therapies also connects to this goal.
• SDG 16: Peace, Justice, and Strong Institutions: The article extensively covers the challenges within the US policymaking landscape, including “political polarization,” “gridlock,” and the consequences of a government shutdown. Ryan’s comments on the need for Congress to write “clear, precise legislation” to limit executive overreach and his call for professionals to “engage with their representatives” speak directly to the need for effective, accountable, and inclusive institutions.

2. What specific targets under those SDGs can be identified based on the article’s content?

Several specific targets can be identified under the relevant SDGs:

1. Under SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
     
     The article directly addresses this target through its focus on making healthcare affordable and accessible. Ryan discusses policies to manage high-cost treatments, proposes a premium support model for Medicare to ensure patient choice, and expresses the desire for “universal care and coverage that’s affordable and better.” The debate over the high price tags of new therapies and how to expand access without “breaking the bank” is central to this target.
2. Under SDG 9: Industry, Innovation, and Infrastructure
   • Target 9.5: Enhance scientific research, upgrade the technological capabilities of industrial sectors in all countries…including…encouraging innovation.
     
     This target is reflected in Ryan’s strong support for AI as a transformative technology in healthcare. His statement that the US is in a “global AI race with China” and should secure a “first-mover advantage” highlights the importance of technological leadership and innovation. Furthermore, his proposal for risk pools to “fund innovative treatments” and “incentivize pharmaceutical development” directly supports enhancing research and technological capabilities in the healthcare sector.
3. Under SDG 16: Peace, Justice, and Strong Institutions
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
     
     The article points to institutional weaknesses when Ryan notes that “Congress often drafts laws too vaguely, granting the executive branch wide discretion.” His argument that Congress must “write clear, precise legislation to limit executive overreach” is a direct call for more effective and accountable legislative institutions. The discussion of political gridlock stalling necessary reforms also points to challenges in institutional effectiveness.
   • Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels.
     
     This target is highlighted by Ryan’s advice to the attendees: “it’s really important that you come through your trade associations and go explain to these policymakers…what the consequences of these decisions are.” He warns that if stakeholders are not engaged, “policy will be written without your knowledge, consent, or input,” emphasizing the need for a more participatory and responsive decision-making process.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article does not provide quantitative data but implies several qualitative and conceptual indicators for measuring progress:

• For Target 3.8 (Universal Health Coverage):
  • Implied Indicator (related to 3.8.1 – Coverage of essential health services): The accessibility of new, innovative treatments (like cell and gene therapies) for the general population. The article frames this as a key challenge, suggesting that successful policies would increase patient access.
  • Implied Indicator (related to 3.8.2 – Financial burden of healthcare): The financial sustainability of national health programs (Medicare) and the affordability of care for individuals. Progress would be measured by the implementation of policies that prevent the system from “bankrupting ourselves” while managing the “high price tags” of modern medicine.
• For Target 9.5 (Innovation):
  • Implied Indicator (related to 9.5.1 – R&D expenditure): The level of investment and incentive structures for pharmaceutical and technological (AI) development. Ryan’s argument for policies that “incentivize pharmaceutical development” suggests that the strength of these incentives could be a measure of progress.
  • Implied Indicator: The rate of adoption and integration of AI technologies into the healthcare system to make care “better, faster, and cheaper.”
• For Targets 16.6 & 16.7 (Strong Institutions):
  • Implied Indicator (for 16.6): The clarity and precision of legislation passed by Congress. A reduction in vaguely written laws that delegate excessive power to the executive branch would indicate progress toward more effective institutions.
  • Implied Indicator (for 16.7): The level of engagement and influence of stakeholder groups (like trade associations and healthcare professionals) in the policymaking process. An increase in their participation, as encouraged by Ryan, would signify more responsive and inclusive decision-making.

4. Table of SDGs, Targets, and Indicators

Source: ajmc.com