Good Intentions, Bad Outcomes: Rethinking Healthcare Policy with Deborah Williams

When Healthcare Policy Incentives Backfire: 340B, Hospital Pricing, MFN, and Drug Affordability with Deborah Williams

Healthcare policies are often evaluated by what they are intended to accomplish. But what happens when the incentives created by those policies produce very different results?

In this episode of RealPharma, Ian Wendt and Dr. Na-Ri Oh speak with longtime health policy expert Deborah Williams about the unintended consequences embedded in the U.S. healthcare system—from hospital reimbursement and industry consolidation to the 340B Drug Pricing Program, biosimilars, most-favored-nation pricing, and pharmaceutical innovation.

Deborah argues that healthcare policy must be judged not by its stated purpose, but by the behaviors, financial incentives, and measurable outcomes it creates. The discussion examines why transparency alone may not lower healthcare costs, how hospital systems use their political and economic influence, and why policies designed to improve affordability can sometimes contribute to higher prices.

The conversation also explores the practical and constitutional uncertainties surrounding most-favored-nation drug pricing, the Trump administration’s GARD, GLOBE, and GENEROUS models, and the potential downstream effects of pricing reform on research, development, manufacturing, and patient access.

Topics Discussed

Why healthcare policy should be evaluated by results rather than intentions

The history and limitations of diagnosis-related groups, or DRGs

Why MACRA has failed to create an effective physician payment system

Whether healthcare price transparency can meaningfully reduce costs

The effects of hospital consolidation and certificate-of-need laws

Why hospital systems have become so politically difficult to challenge