America has to do the hard thing: get rid of private health care providers/corporations. You need a national, universal health care system. Like other western nations. And don't be quiet about anything, Democrats. Use your outside voice!
Unfortunately, the billionaires that have been created since Richard Nixon signed the HMO Act of 1973, changing the structure of American healthcare from a community-focused system to a market-based, profit-driven system, will have plenty to say about that. This is how privatization works. It creates oligarchs, and they won't give up their seats on the gravy boat quietly. The public pays for it.
Trump always does what he says he will...and with a Republican Senate and Republican House nothing could hold him back.
"Under my administration we will be slashing energy and electricity prices BY HALF within 12 months, at a maximum of 18 months". 8/14/24
"Starting on day one, we will end inflation and make America affordable again, to bring down the prices of all goods."
Trump Rally in Bozeman, MT. YouTube (August 9, 2024).
"Prices will come down. You just watch: They'll come down, and they'll come down fast, not only with insurance, with everything."
(August 14, 2024).
"Starting the day I take the oath of office, I will rapidly drive prices down and we will make America affordable again. We're going to make it affordable again."
"Energy is going to bring us back. That means we're going down and getting gasoline below $2 a gallon, bring down the price of everything from electricity rates to groceries, airfares, and housing costs."
9/5/24
"We will eliminate regulations that drive up housing costs with the goal of cutting the cost of a new home in half. We think we can do that."
(September 5, 2024).
"While working Americans catch up, we're going to put a temporary cap on credit card interest rates. We can't let them make 25 and 30%."
9/18/24
"We're going to get the prices down. .....we are going to put a temporary cap on credit card interest rates at 10%. People are being made to pay 25%. Temporary ban."
It is sad that these wannabee dictators never use their power for good, do they? Trump and Putin could have made legendary contributions to the betterment of the human race, but all they did was use oppression to fill their personal piggy banks and hurt others. SMH.
I have never understood why healthcare was tied to employers. It creates situations that keep people in jobs for fear of losing healthcare. But when (not if) millions of people start losing their jobs to AI that will very quickly change. I fear that any future plans won’t be up and running before that disaster hits home. Kudos to Wyden(my senator) and Sanders for leading on this!
We should devise a Health Care System that takes the best aspects of systems used in: The Netherlands, Japan, Canada, S. Korea, Switzerland, Taiwan, Ireland, Australia, and Norway.
Thank you for this article. Between the No Kings 3 turnout (especially in rural areas) and the information the Democrats are at least thinking forward gives me hope. The Republicans were up and running (with their Project 2025 game plan) on Day 1. We should also do the same. And in my humble opinion I think we should swing big - the people are fed up and ready. Thanks again for great reporting.
Re footnote #3. Unfortunately Sen. Kennedy passed in Aug of 2009 and I don't recall him being involved in shaping the ACA even in the early days of the Obama administration that began in Jan. 2009.
I'm sorry, but after reading about possible Democratic ideas outlined in this great piece, it fails in terms of the bar these advocates set; "we don’t fall into a trap of defending the status quo that people thought rightly was broken"
First any REAL legislation to address our nations health is reforming the farm bill--legislation that subsides farmers to grow crappy corn, wheat and other key foods for in feeding cattle AND ultraprocessed foods--to promote the growth of healthy eating instead of slop. That is a lift that is 10 times harder than health care reform and one could argue that other types of health care reform is performative.
Also, these "solutions" are just moving the chairs around the deck of the Titanic. Negotiating pricing, controlling pricing of procedures and trimming hospitals "surplus cash" and insurance companies profit is small ball compared to the exploding costs of new innovative treatments that can cost 7 figures. How does our health care system absorb $3.5 million procedures to cure rare genetic diseases or when the drug that cures Alzheimer someday (hopefully) costs more than the current care?
Also, while I'm not a "M4A" fan, I do think the concept of insurance is obsolete given modern medicine. Popularized in the 40's and 50's, employer paid health insurance easily could be a profitable business while offering real value to customers back then. That's because health care back then was for having babies and broken bones. Cancer? Heart Disease? Back then they confirmed the diagnose and that was all they could do. Today, we have treatments for nearly every aliment and the cost of each innovation is mind-boggling. (Which is why I was surprised none of the discussion focuses on this cost reality today that will only get worse in the future).
Reform of Farm Bill is a great idea--there might even be some bipartisan support for that. RFK’s vaccine idiocy has been beyond horrible and dangerous; but his efforts against the very bad health effects of processed food are something a majority of Americans can probably agree on
Majority of Americans also probably agree that monopolistic corporations profiting off of super unhealthy ultra processed foods is very bad.
Even if we get that done, tho, we are still going to need Universal Healthcare Coverage. Perhaps through the non-profit health insurance company model used in Germany, France, Belgium, Switzerland, and Japan
The hottest topic around health care in Iowa is rural and small-town clinics closing or cutting services. In February a large health system shut down a clinic in the city of Ottumwa (population around 25,000). Many people will have to drive 30-45 minutes to see a doctor now.
We just learned that a hospital in Clinton, Iowa (population around 24,000) is going to end labor and delivery services in May.
Iowa Democratic politicians and candidates have been talking about these closures a lot and connecting the dots to the Medicaid cuts in the budget reconciliation bill. But I don't think anyone has proposed a solution, other than restoring Medicaid funding.
Thank you as always for your comprehensive article. And for your passion around healthcare equity. And for all your wonderful work around the RFK jr/MAHA nightmare.
But again, I want to emphasize the fact that the Bulwark does not address family planning, reproductive rights and abortion as healthcare. Cleaning up the “affordable healthcare” requires that we reverse the draconian Hyde amendment, allow women access to decisions about their own bodies, and continue treating contraception as preventive care. And your site needs to not be scared to tackle these issues.
I don’t believe you’ve ever written an article specifically about women and healthcare.
I’m here in Maine, where Graham Platner will probably be our next Senator. Graham’s big on universal health care coverage--I very much am too. I don’t, however, think Medicare for All is politically feasible. TR Reid has pointed out that Germany, France, Belgium, Switzerland, Japan all use non-profit health insurance companies--I think this would be much less of a jolt and more politically feasible. The Clintons tried to completely take down the health insurance companies--that can’t work, they’re too rich and powerful
Thanks for the references on a few of the plans the Democrats are working on. (I note that, with the exception of the Sanders single-payer standby, they are all small steps.)
For completeness of information, and at the risk of frustrating everyone who lives here in the U.S., I mention that except for Sanders' single-payer, nothing would be a program that covers long-term-care / nursing homes.
Long-term care / nursing homes, generally referred to in healthcare language as "long term supports and services" (LTSS), is care like nursing homes and home care that is for people disabled by aging or other reasons, that is not primarily focused on treating a disease, but rather is focused on helping a person function by helping with dressing and daily activities, etc.
As the NY Times reported the other day, ( https://www.nytimes.com/2026/03/27/your-money/long-term-care-insurance.html ), the very-high costs (for nursing homes, averaging $130,000 a year, and higher in some states) are not covered by Medicare, nor by any other medical insurance, except for private nursing-home insurance, which only about 15 percent of people over 65 have.
(Note: For many people, private nursing home insurance is too expensive. It is also pre-existing-condition screened, so many people may not be able to get it at all. Further, it is sometimes inadequate, covering care only for a limited number of years, or inadequate daily costs.)
--
In the U.S., much long-term-care, particularly nursing homes, winds up being paid for by the government, through Medicaid.
The thing about the U.S. system is, though, that in order to have Medicaid pay for nursing homes, the individual, or married couple with a member in a nursing home, has to first pay the full cost of the nursing home until they have spent down to meet the Medicaid requirements of being dirt-poor in both income and assets. (When one member of a married couple is in a nursing home, the spouse is allowed to keep a minimal amount of assets and income--but not much!)
It's a real hardship, and, in fact, for married couples, there is sometimes a solution used of "Medicaid Divorce".
I had wondered about the rest of the developed world on this. We all know that virtually everywhere else in the developed world, expenses for non-LTSS medical care are much less of a problem than here. (And thus, the proposals Jonathan Cohn mentions are attempts to help, at least a little, with that.)
So, I did some research on LTSS.
Apparently, in the U.K., for LTSS, it's pretty much like here. You have to spend down.
However, in many other of the countries, it's not nearly as bad as here.
For example, Canada has various province-wide systems, that limit what people have to pay to $2,000 - $4,000 (CDN) a month. And they don't have to spend down first! (Note a CDN dollar is about 3/4 or a U.S. dollar, so the numbers are lower in U.S. dollars. Also note the U.S. nursing-home cost is about $9,000-$16,000 (U.S. dollars) a month, depending on where you live.)
Now, note: for many of us, we see that in Canada you would have to pay much less than here, and we might calculate that we have enough savings to afford that.
Still, from those monthly rates alone, some people might have trouble. Particularly, I might worry about the member of a couple not in a nursing home when one member is in. So, there is still a question of whether some people would be put in big financial trouble by a nursing home, or, are there other programs which would relieve them? (I do not know the answer. Perhaps clicking on those links in the Canada table would get one to information about those supplemental programs.)
--
For some other wealthy countries: for example Japan, Norway, France, Germany, and the Netherlands. they have some sort of system for LTSS coverage that seems closer to Canada, perhaps even better than Canada. Certainly, not a spend-down-completely first system for LTSS, like the U.S. and U.K.
However, as with Canada, it is unclear, from the limited information I have been able to find, whether or not certain people, without a lot of savings and/or income, will get into severe financial distress over LTSS costs.
We ran into this 26 years ago when my dad had a brain bleed and would need full time nursing home care. We were stunned as six children of parents (both of whom grew up poor) who did everything right to save for future and put their six children through college only to discover Medicare did not cover this care. More surprising, I was a young health care lawyer who worked in Medicare regs all day but missed this giant hole in coverage. My mom was told she would have to sell her home and spend down those assets. I joke now that my dad heard that news from his ICU bed and efficiently died within 12 hours. He worked to hard to buy that house and pay it off! But here’s where we run into a prob as a country. Who pays for any new benefit? Our country is almost bankrupt and cannot afford the Medicare system we have now. Medicare needs to be cut somewhere to pay for anything new. Most of these long term care benefits would go to people over 65 once again forcing our country to spend over half its budget on the elderly while spending comparatively little on the young, the future of the country. We have to find some balance that keeps older people out of poverty, takes care of the most needy young people and invests in the education system for them, fixes social security for the long term AND does not bring on a debt crisis and perpetuate $1 trillion per year INTEREST payments which provide not services or goods to anyone.
Go big Dems and please for God’s sake, define the issue yourselves. Don’t let the GOP & their media allies do it for you. Learn the Obama/Biden lesson. Sell the accomplishments so everyone understands them.
America has to do the hard thing: get rid of private health care providers/corporations. You need a national, universal health care system. Like other western nations. And don't be quiet about anything, Democrats. Use your outside voice!
Universal healthcare would be nice
Unfortunately, the billionaires that have been created since Richard Nixon signed the HMO Act of 1973, changing the structure of American healthcare from a community-focused system to a market-based, profit-driven system, will have plenty to say about that. This is how privatization works. It creates oligarchs, and they won't give up their seats on the gravy boat quietly. The public pays for it.
Trump always does what he says he will...and with a Republican Senate and Republican House nothing could hold him back.
"Under my administration we will be slashing energy and electricity prices BY HALF within 12 months, at a maximum of 18 months". 8/14/24
"Starting on day one, we will end inflation and make America affordable again, to bring down the prices of all goods."
Trump Rally in Bozeman, MT. YouTube (August 9, 2024).
"Prices will come down. You just watch: They'll come down, and they'll come down fast, not only with insurance, with everything."
(August 14, 2024).
"Starting the day I take the oath of office, I will rapidly drive prices down and we will make America affordable again. We're going to make it affordable again."
"Energy is going to bring us back. That means we're going down and getting gasoline below $2 a gallon, bring down the price of everything from electricity rates to groceries, airfares, and housing costs."
9/5/24
"We will eliminate regulations that drive up housing costs with the goal of cutting the cost of a new home in half. We think we can do that."
(September 5, 2024).
"While working Americans catch up, we're going to put a temporary cap on credit card interest rates. We can't let them make 25 and 30%."
9/18/24
"We're going to get the prices down. .....we are going to put a temporary cap on credit card interest rates at 10%. People are being made to pay 25%. Temporary ban."
9/29/24
It is sad that these wannabee dictators never use their power for good, do they? Trump and Putin could have made legendary contributions to the betterment of the human race, but all they did was use oppression to fill their personal piggy banks and hurt others. SMH.
I have never understood why healthcare was tied to employers. It creates situations that keep people in jobs for fear of losing healthcare. But when (not if) millions of people start losing their jobs to AI that will very quickly change. I fear that any future plans won’t be up and running before that disaster hits home. Kudos to Wyden(my senator) and Sanders for leading on this!
We should devise a Health Care System that takes the best aspects of systems used in: The Netherlands, Japan, Canada, S. Korea, Switzerland, Taiwan, Ireland, Australia, and Norway.
Thank you for this article. Between the No Kings 3 turnout (especially in rural areas) and the information the Democrats are at least thinking forward gives me hope. The Republicans were up and running (with their Project 2025 game plan) on Day 1. We should also do the same. And in my humble opinion I think we should swing big - the people are fed up and ready. Thanks again for great reporting.
Re footnote #3. Unfortunately Sen. Kennedy passed in Aug of 2009 and I don't recall him being involved in shaping the ACA even in the early days of the Obama administration that began in Jan. 2009.
I'm sorry, but after reading about possible Democratic ideas outlined in this great piece, it fails in terms of the bar these advocates set; "we don’t fall into a trap of defending the status quo that people thought rightly was broken"
First any REAL legislation to address our nations health is reforming the farm bill--legislation that subsides farmers to grow crappy corn, wheat and other key foods for in feeding cattle AND ultraprocessed foods--to promote the growth of healthy eating instead of slop. That is a lift that is 10 times harder than health care reform and one could argue that other types of health care reform is performative.
Also, these "solutions" are just moving the chairs around the deck of the Titanic. Negotiating pricing, controlling pricing of procedures and trimming hospitals "surplus cash" and insurance companies profit is small ball compared to the exploding costs of new innovative treatments that can cost 7 figures. How does our health care system absorb $3.5 million procedures to cure rare genetic diseases or when the drug that cures Alzheimer someday (hopefully) costs more than the current care?
Also, while I'm not a "M4A" fan, I do think the concept of insurance is obsolete given modern medicine. Popularized in the 40's and 50's, employer paid health insurance easily could be a profitable business while offering real value to customers back then. That's because health care back then was for having babies and broken bones. Cancer? Heart Disease? Back then they confirmed the diagnose and that was all they could do. Today, we have treatments for nearly every aliment and the cost of each innovation is mind-boggling. (Which is why I was surprised none of the discussion focuses on this cost reality today that will only get worse in the future).
Reform of Farm Bill is a great idea--there might even be some bipartisan support for that. RFK’s vaccine idiocy has been beyond horrible and dangerous; but his efforts against the very bad health effects of processed food are something a majority of Americans can probably agree on
Majority of Americans also probably agree that monopolistic corporations profiting off of super unhealthy ultra processed foods is very bad.
Even if we get that done, tho, we are still going to need Universal Healthcare Coverage. Perhaps through the non-profit health insurance company model used in Germany, France, Belgium, Switzerland, and Japan
Whoops, I meant to say RFK Jr....
About time
The hottest topic around health care in Iowa is rural and small-town clinics closing or cutting services. In February a large health system shut down a clinic in the city of Ottumwa (population around 25,000). Many people will have to drive 30-45 minutes to see a doctor now.
We just learned that a hospital in Clinton, Iowa (population around 24,000) is going to end labor and delivery services in May.
https://www.wqad.com/article/news/local/mercyone-clinton-medical-center-ending-labor-delivery/526-f7772e25-3807-441a-aa53-af8f8ac26acf
Iowa Democratic politicians and candidates have been talking about these closures a lot and connecting the dots to the Medicaid cuts in the budget reconciliation bill. But I don't think anyone has proposed a solution, other than restoring Medicaid funding.
Thank you as always for your comprehensive article. And for your passion around healthcare equity. And for all your wonderful work around the RFK jr/MAHA nightmare.
But again, I want to emphasize the fact that the Bulwark does not address family planning, reproductive rights and abortion as healthcare. Cleaning up the “affordable healthcare” requires that we reverse the draconian Hyde amendment, allow women access to decisions about their own bodies, and continue treating contraception as preventive care. And your site needs to not be scared to tackle these issues.
I don’t believe you’ve ever written an article specifically about women and healthcare.
Thanks Jonathon for this article!
I’m here in Maine, where Graham Platner will probably be our next Senator. Graham’s big on universal health care coverage--I very much am too. I don’t, however, think Medicare for All is politically feasible. TR Reid has pointed out that Germany, France, Belgium, Switzerland, Japan all use non-profit health insurance companies--I think this would be much less of a jolt and more politically feasible. The Clintons tried to completely take down the health insurance companies--that can’t work, they’re too rich and powerful
For more, see these two links:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3596027/
https://pnhp.org/news/t-r-reids-the-healing-of-america/
Thanks for the references on a few of the plans the Democrats are working on. (I note that, with the exception of the Sanders single-payer standby, they are all small steps.)
For completeness of information, and at the risk of frustrating everyone who lives here in the U.S., I mention that except for Sanders' single-payer, nothing would be a program that covers long-term-care / nursing homes.
Long-term care / nursing homes, generally referred to in healthcare language as "long term supports and services" (LTSS), is care like nursing homes and home care that is for people disabled by aging or other reasons, that is not primarily focused on treating a disease, but rather is focused on helping a person function by helping with dressing and daily activities, etc.
As the NY Times reported the other day, ( https://www.nytimes.com/2026/03/27/your-money/long-term-care-insurance.html ), the very-high costs (for nursing homes, averaging $130,000 a year, and higher in some states) are not covered by Medicare, nor by any other medical insurance, except for private nursing-home insurance, which only about 15 percent of people over 65 have.
(Note: For many people, private nursing home insurance is too expensive. It is also pre-existing-condition screened, so many people may not be able to get it at all. Further, it is sometimes inadequate, covering care only for a limited number of years, or inadequate daily costs.)
--
In the U.S., much long-term-care, particularly nursing homes, winds up being paid for by the government, through Medicaid.
The thing about the U.S. system is, though, that in order to have Medicaid pay for nursing homes, the individual, or married couple with a member in a nursing home, has to first pay the full cost of the nursing home until they have spent down to meet the Medicaid requirements of being dirt-poor in both income and assets. (When one member of a married couple is in a nursing home, the spouse is allowed to keep a minimal amount of assets and income--but not much!)
It's a real hardship, and, in fact, for married couples, there is sometimes a solution used of "Medicaid Divorce".
I had wondered about the rest of the developed world on this. We all know that virtually everywhere else in the developed world, expenses for non-LTSS medical care are much less of a problem than here. (And thus, the proposals Jonathan Cohn mentions are attempts to help, at least a little, with that.)
So, I did some research on LTSS.
Apparently, in the U.K., for LTSS, it's pretty much like here. You have to spend down.
However, in many other of the countries, it's not nearly as bad as here.
For example, Canada has various province-wide systems, that limit what people have to pay to $2,000 - $4,000 (CDN) a month. And they don't have to spend down first! (Note a CDN dollar is about 3/4 or a U.S. dollar, so the numbers are lower in U.S. dollars. Also note the U.S. nursing-home cost is about $9,000-$16,000 (U.S. dollars) a month, depending on where you live.)
(There is a table, by Canadian province, within: https://hillnotes.ca/2025/01/16/long-term-care-facilities-in-canada-how-are-they-funded-and-regulated/ , that may be helpful. It also has a lot of embedded links, that may let you get to finer details than in the table itself.)
Now, note: for many of us, we see that in Canada you would have to pay much less than here, and we might calculate that we have enough savings to afford that.
Still, from those monthly rates alone, some people might have trouble. Particularly, I might worry about the member of a couple not in a nursing home when one member is in. So, there is still a question of whether some people would be put in big financial trouble by a nursing home, or, are there other programs which would relieve them? (I do not know the answer. Perhaps clicking on those links in the Canada table would get one to information about those supplemental programs.)
--
For some other wealthy countries: for example Japan, Norway, France, Germany, and the Netherlands. they have some sort of system for LTSS coverage that seems closer to Canada, perhaps even better than Canada. Certainly, not a spend-down-completely first system for LTSS, like the U.S. and U.K.
However, as with Canada, it is unclear, from the limited information I have been able to find, whether or not certain people, without a lot of savings and/or income, will get into severe financial distress over LTSS costs.
(For those interested, I took what I have been able to figure out, and stuck it in a post https://normspier828307.substack.com/p/paying-for-nursing-homes-and-long .)
However, I need better information.
If anyone has any better references, or better information about particular countries and LTSS, I would appreciate a comment!
We ran into this 26 years ago when my dad had a brain bleed and would need full time nursing home care. We were stunned as six children of parents (both of whom grew up poor) who did everything right to save for future and put their six children through college only to discover Medicare did not cover this care. More surprising, I was a young health care lawyer who worked in Medicare regs all day but missed this giant hole in coverage. My mom was told she would have to sell her home and spend down those assets. I joke now that my dad heard that news from his ICU bed and efficiently died within 12 hours. He worked to hard to buy that house and pay it off! But here’s where we run into a prob as a country. Who pays for any new benefit? Our country is almost bankrupt and cannot afford the Medicare system we have now. Medicare needs to be cut somewhere to pay for anything new. Most of these long term care benefits would go to people over 65 once again forcing our country to spend over half its budget on the elderly while spending comparatively little on the young, the future of the country. We have to find some balance that keeps older people out of poverty, takes care of the most needy young people and invests in the education system for them, fixes social security for the long term AND does not bring on a debt crisis and perpetuate $1 trillion per year INTEREST payments which provide not services or goods to anyone.
x
Go big Dems and please for God’s sake, define the issue yourselves. Don’t let the GOP & their media allies do it for you. Learn the Obama/Biden lesson. Sell the accomplishments so everyone understands them.