My brother sent me this attempt at a one-pager on healthcare in the US, and I thought it was a pretty good summary of our common disaster:
First, our health system is not affordable, either for people or for the country. About a quarter of the public struggle with their medical bills and the numbers rise sharply for people with chronic illnesses or major diseases who need a lot of care. About 100 million deal with medical debt. We spend almost twice per capita what other wealthy nations spend, putting pressure on other national priorities and for employers on wages.
Despite progress, we still have 27 million people who are uninsured, and according to projections from the Congressional Budget Office, cuts in the One Big Beautiful Bill will bring that total to about 40 million if the cuts aren’t reversed.
The system is beyond complex and challenging to navigate. The poster child of this is prior authorization review, which almost everyone hates. People tell us on surveys that it’s their single greatest problem getting care.
As is well known, although we spend much more than other wealthy nations, our health outcomes lag behind theirs in most cases. There are a lot of different ingredients in that stew, but our well-heeled health system has not lifted our health outcomes.
Trust in health professionals remains strong, but trust in critical agencies such as the Centers for Disease Control and Prevention and the Food and Drug Administration is at a low point. The agencies take it on the chin for different reasons from both Democrats and Republicans. If we have another COVID-like crisis, we’ll pay a big price for that; national emergencies, like wars, cannot be handled state by state.
If I were to nominate one more item for the list, it would be the “crisis” in primary care. In many parts of the country, it’s just not easily available, and in some, like the Silicon Valley where I live, much of it has been skimmed off to expensive concierge practices with long waiting lists.
Finally, the politics of health care are as broken as the system (and are a reason it is broken). For decades, Democrats and Republicans have not been able to agree on any major solutions to our health care problems and disagree sharply on the role of the federal government in health, forcing us to gravitate to smaller incremental changes where there might be some agreement. They also blow their importance out of proportion. I won’t name names in this short piece.
The result: we have neither a competitive health care system nor a regulated one—we have a fragmented, micromanaged health system that fails to control costs and makes both patients and health professionals more miserable than they should be.
Of course, if you have a problem requiring a world-renowned specialist or the very latest drug and can get to and afford her, him, or it, it can be the greatest health system in the world.
One quibble: it’s not just that Democrats and Republicans can’t agree, it’s that Republicans actively fight and undermine any efforts to make our healthcare system better.
Speaking of the CDC and FDA, apparently the raccoon penis collector in charge is trying to extend a few olive branches and it isn’t going very well:
[…] Robert F. Kennedy Jr. and his health department deputies have pared back the insults this year. They’ve even occasionally had nice things to say about the civil servants who work for them. They’re hiring again after the DOGEing of 2025. The shift coincides with a broader shakeup of agency leadership that the department has said is about producing better results for the American people.
More than a dozen federal employees and contractors who work inside the Department of Health and Human Services told POLITICO they’ve noticed the change in tone, but aren’t seeing as much in the way of substance. They said they continue to distrust Kennedy and his deputies’ policy decisions. But some also said the open hostility towards career employees and the daily chaos that marked 2025 has given way to some semblance of routine, as the longtime employees who hung on try to get their work done without attracting Kennedy’s attention. Many pointed to fear of retribution as their reason for not wanting to be named.
“They’ve cultivated an environment of mistrust and abuse over the last year and a half,” said one contractor at the Centers for Disease Control and Prevention, the agency Kennedy has most often maligned. “People are not just going to forget what’s been done.”
This seems to be a bit of a pattern with Trump’s horrible nominees who stay in their jobs (i.e., the males). They first come through and break everything, then they try the bully’s favorite trick — “just kidding” — in order to, I don’t know, maybe get something done? Perhaps get some of the heat off of them? I really don’t understand the strategy, such as it is, because as usual they expect their victims to have no agency, no pushback.
If there’s any lesson to be learned here, it’s that passing Obamacare, with its known flaws, and betting that we can fix it in the future is a strategy for the last century, not this one. When Democrats had huge majorities in Congress and somewhat cooperative Presidents, especially some of the Republican ones who had some interest in making things better, big legislation like Social Security, Medicare and the like could have regular “tweaks”. This cannot happen anymore. The current Republican Party is only interested in breaking things. The response to the way they’ve wrecked our healthcare system has to be big, bold and built to be hard to dismantle. Otherwise, the next RFK Jr will come through and break it. We also need some kinds of serious, criminal penalties for members of the Executive Branch who just ignore the black letter law of Congressional appropriations and authorizations. These guys are breaking the law to get what the want, and they’re going to experience little or no consequence for it. That has to change.
