U.S. Healthcare – A System Purposely Designed to Benefit the Wealthy and Take from the Rest

 

U.S. Healthcare – A System Purposely Designed to Benefit the Wealthy and Take from the Rest

If you come from a wealthy family, there is so much good news these days. Your taxes will enjoy the largest cut in modern American history under Trump’s Big Beautiful Bill. Students facing massive student loan repayments are having their wages garnished, assuming they can find a job, money for medical research, rural hospitals, student loans for nursing students and subsidies for Affordable Care Act (“Obamacare”) recipients are going or gone… so those burdens have been or will soon be purged from the federal budget… ensuring lower taxes for the foreseeable future. People will be offered a highly discriminatory alternative of buying their own healthcare policies, with premiums, exclusions and caps (particularly on pre-existing conditions… which 40% of adult Americans have) favoring younger, healthier Americans and making health insurance considerably more limited and expensive for the rest.

So, with fewer nurses, higher insurance costs and fewer alternatives for the pre-Medicare group, we may return to the chaos and mass on uninsured Americans that existed before the ACA passed (2010) and when most of its benefits kicked in (2013). The ACA covers roughly 7% of the population, and the ban against those exclusions and limits for preexisting conditions covered most everybody. Bye-bye. California provides a more expansive ACA-driven healthcare exchange (Covered California), has opted for a more comprehensive Medicaid plan, but even California is struggling with how to keep its citizens insured. Since the United States is the only developed nation on Earth without comprehensive universal healthcare, not only are we the outlier… we are actually stepping back from coverage.

Odd that those most likely to see healthcare vaporize are residents in largely rural red states and communities… even in California. Placer County [east of Sacramento to the Nevada border] health officials there and across the country are bracing for an estimated 10 million newly uninsured patients over the next decade in the wake of Republicans’ One Big Beautiful Bill Act.

“The act, which President Trump signed into law this summer, is expected to reduce Medicaid spending by more than $900 billion over that period… ‘This is the moment where a lot of hard decisions have to be made about who gets care and who doesn’t,’ said Nadereh Pourat, director of the Health Economics and Evaluation Research Program at UCLA. ‘The number of people who are going to lose coverage is large, and a lot of the systems that were in place to provide care to those individuals have either gone away or diminished.’

“It’s an especially thorny challenge for states such as California and New Mexico, where counties are legally required to help their poorest residents through what are known as indigent care programs. Under Obamacare, both states were able to expand Medicaid to include more low-income residents, alleviating counties of patient loads and redirecting much of their funding for the patchwork of local programs that provided bare-bones services… Placer County, which estimates that 16,000 residents could lose healthcare coverage by 2028, quit operating its own clinics nearly a decade ago… ‘Most of the infrastructure that we had to meet those needs is gone,’ said Rob Oldham, Placer County’s director of health and human services. ‘This is a much bigger problem than it was a decade ago and much more costly.’

“In December, county officials asked to join a statewide association that provides care to mostly small, rural counties, citing an expected rise in the number of uninsured residents…’ New Mexico’s second-most populous county, Doña Ana, added dental care for seniors and behavioral health benefits after many of its poorest residents qualified for Medicaid. Now, federal cuts could force the county to reconsider, said Jamie Michael, Doña Ana’s health and human services director… ‘At some point we’re going to have to look at either allocating more money or reducing the benefits,’ Michael said.” Christine Mai-Duc and Claudia Boyd-Barrett, writing for the December 27th Los Angeles Times.

Small hospitals are closing. There is a severe doctor and an even greater nursing shortage – but unlike professional nurses, MD candidates have allocated federal resources for student loans… plus federal aid once appropriated to train more nurses has been severely slashed, which adds to the existing problem of securing medical staff. “Nursing, the nation's largest health care profession, is in critical condition. The U.S. faces a shortfall of more than 78,000 full-time registered nurses this year alone, and California's projected nursing workforce gap is among the largest [California accounts for 10% of US nurses]. Nurses are fleeing the profession for familiar reasons: an aging workforce, high turnover and burnout that began long before the COVID pandemic and only deepened after it. But an overlooked cause of this crisis isn't at the bedside - it's in the classroom.

“Nursing schools are not the problem. They are operating under mounting challenges including budget cuts, hiring freezes and a significant number of nurse faculty retirements. Those who remain will take on higher workloads. Not only do we teach in classrooms, but we also scramble to secure training sites for our students and plead with busy clinicians to supervise them during hands-on training in clinical settings. This challenge is particularly severe for California nursing schools, where limited access to clinical placements remains the top obstacle to expanding enrollment...

“The recently-killed Nurse Faculty Loan Repayment program cancels up to 85% of educational loans for those who commit to teach for four years. I know firsthand how vital this program is - it's the only reason I can afford to teach and live in California.

“Congress can pass legislation like the Nursing Workforce Reauthorization Act of 2025, which would maintain funding for nursing education at current levels. This bill has bipartisan support. The Department of Education must recognize nurses as a profession that qualifies for more federal student loans, particularly in states where the cost of living makes academic careers financially precarious.

“For every nurse who's held your hand, helped you deliver a baby or cared for a loved one, there was a nurse educator who taught them how. It's time for us to show America's most trusted profession how much we value them.” My Hanh (Theresa) Nguyen, PhD, a board certified psychiatric-mental health nurse practitioner and an associate professor in the Hahn School of Nursing and Health Science at the University of San Diego as well as a recent alumna of UCLA's National Clinician Scholars Program… Writing for the December 19th Sacramento Bee.” For the developed world’s most expensive healthcare system, we have no excuse for allowing millions of Americans to settle for no or severely limited coverage.

I’m Peter Dekom, and after blogging about healthcare even before the ACA was enacted, we still prioritize wealth over healthcare, and the ONLY solution to this embarrassing anomaly is for us to join the rest of the developed world and offer comprehensive universal healthcare.