Jeff Pierce is a former Maine state representative, contractor and real estate developer.

In Maine, we tend to value straight talk. Whether you’re out on the water before sunrise, running a small business or just trying to keep up with bills at the kitchen table, you don’t have much patience for systems that aren’t clear or don’t add up.

That’s how a lot of Mainers feel about healthcare right now.

Costs keep going up. But getting a straight answer on why or where all that money is going isn’t always so simple. And that’s really the point. If we’re serious about fixing healthcare, transparency has to come first, not last, and it can’t be an afterthought.

There are a couple issues in Washington getting attention lately that really bring this home: the growth of the federal 340B drug pricing program and increasing frustration, understandably, with health insurance companies. Different topics, sure. But they point to the same underlying problem: patients are too often left guessing.

The 340B program started with a pretty straightforward goal: help ensure low-income and rural patients have access to affordable medicines. That still matters, especially in a state like ours, where access isn’t something Mainers can take for granted.

But like a lot of things in healthcare, the program hasn’t stayed small.

A 2025 report from the Congressional Budget Office, the first major review of the program in years, found that spending on drugs purchased through 340B grew from $6.6 billion in 2010 to $43.9 billion in 2021, a pace that’s much faster than overall drug spending. The report also points to hospital expansion and the growth of affiliated outpatient clinics as major drivers of that increase.

Now, most people aren’t concerned by program growth alone.

The bigger question, and the one that’s considerably harder to answer, is whether patients are seeing the benefit of the program. Are those savings making prescriptions more affordable? Are they helping people access care sooner, or more easily?

Right now, it’s tough to say. There’s no consistent, easy-to-understand way for patients (or frankly, policymakers) to see how 340B savings are used or how much is passed along at the pharmacy counter. And when programs aren’t transparent, they’re hard to trust.

At the same time, people across Maine are dealing with something a lot more immediate: the rising cost of health insurance.

Polling of Maine voters earlier this year found that 73% say premiums, deductibles and coverage denials are their biggest healthcare pain points. That shouldn’t surprise anyone who’s had to navigate the system lately. You can have insurance, follow the rules, do everything right — and still end up with bills that don’t quite make sense. Or coverage decisions that feel arbitrary. Or both.

If you step back for a second, these issues really aren’t separate. Whether it’s how 340B dollars are used or how insurance companies make decisions, the common thread is pretty simple: people don’t have a clear view of how the system actually works. And that’s a real problem.

To be clear, this isn’t about assigning blame. Maine’s hospitals are important, especially in rural parts of the state. Insurance coverage matters too. Nobody is suggesting otherwise.

But trust in the system depends on people being able to understand it. And right now, while healthcare costs continue to rise, too much of it feels out of view. There are practical ways to improve that.

For 340B, that starts with clearer reporting — plain information about how savings are generated and, just as importantly, how much of that is reaching patients directly. Not complicated filings that only experts can parse, but something people can actually follow, and information policymakers can use to inform thoughtful reforms.

For insurers, it means more transparency around pricing, coverage decisions and what’s really driving premium increases. People shouldn’t have to guess what something will cost until the bill shows up, or struggle to understand why a treatment may not be covered.

These aren’t big, sweeping ideas. They’re pretty basic, actually.

In a place like Maine, where people rely on common sense and a fair deal, it shouldn’t be too much to expect a healthcare system that’s at least understandable, or maybe even predictable, once in a while.

Fixing healthcare isn’t going to happen overnight; everyone knows that. But bringing more transparency into the system is a realistic place to start. And honestly, it’s overdue. At the end of the day, patients deserve a system that is clear, straightforward and built with them in mind.