With a variety of candidates vying for the Republican presidential nomination and President Joe Biden seeking re-election in the wake of the COVID-19 pandemic, health policy will remain a central issue for voters in the 2024 election. With key health agencies such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health arguably appropriate targets for reform, we turn to the market regulator that oversees products representing 20 percent of US consumer expenditures: the Food and Drug Administration (FDA). Here, we outline a vision of an innovation-driven future for the FDA, using the agency’s regulatory role to promote competition and innovation to drive lower-cost, more efficient and effective health care for Americans.