The basic equation in healthcare is pretty straightforward. People are initially healthy and strive, if wise, to maintain their health. But illnesses inevitably occur, hopefully something acute and the patient
returns to good health.
But with aging, illnesses can become recurrent or chronic. Patients may need or opt to see a healthcare provider to sort out and manage their malady. Back in the day, that fee could be something bartered or paid out of pocket. But as new and better diagnostics and treatments evolved with medications or surgical or other procedural interventions, the cost of providing good care increased. Patients could self-pay, or band together to share the expenses by forming insurable entities.
In the U.S., employers began to offer insurance coverage as part of compensation of their employees. The transactional nature of capitalism and the steady progress in diagnostics and therapies made the costs increasingly expensive, so healthcare coverage became an increasingly important part of the calculus of getting or staying at a job. Costs got increasingly out of hand such that the government needed to jump in to help cover the expense. So we eventually got Medicaid (for economically disadvantaged) and Medicare (for seniors and disabled). Diseases got so complex that being a traditional general practitioner became increasingly difficult so that specialists evolved to better focus on targeted disease states or technical requirements.
As costs exploded, the percentage of the governments contribution to healthcare expenditures rose alarmingly, and for over the last 100 years, public health experts and economists have tried to rein in costs with varying degrees of healthcare reform efforts. Some worked a bit to slow the rate of rise, but none have been the panacea all have sought to actually control the costs.
In 2024, the last year where we have relatively complete data, the cost of healthcare in the U.S. was an astounding $5.3 trillion, or 18.3% of the U.S. GDP, the largest item in the federal budget, not counting the $40 trillion debt and commensurate interest payments on that debt exacerbated by unwise tax cuts …another topic. And more than a quarter of the entire federal debt accrued over this nation’s 250-year existence has been generated in Donald Trump’s first and half of his second presidency. That is, in almost six years, and he’s not done yet. But it’s a financial legacy, or albatross, that will be borne by our children and grandchildren.
And, yes, the debt grew during the Biden administration, but that was due to the COVID-driven decision to pump money into the system to fund the pandemic response and avoid more bankruptcies caused by the economic disaster caused by COVID. The choice was another Great Depression or worse inflation, and the Biden administration chose the latter. Trump’s tax breaks and DOGE slashing of government infrastructure are focused on shifting money to the über wealthy, his cronies and backers, if you’ve been paying attention.
Rational efforts to control costs would be to seek greater efficiencies in the procurement and delivery of healthcare by regulatory and policy initiatives, as private and public entities have done in past and present, but perhaps even more important is to invest in education and prevention to reduce the incidence of preventable diseases and the resultant costs of care.
Instead, what we have seen in this administration is a gutting of prevention and public health programs, upending evidence based education, and disrupting the future science that looks for new treatments and defunding biomedical scientists to do that research. It has chosen to not develop targeted strategies to reduce unnecessary costs, but to use wholesale cutting of budgets. Rather like doing brain surgery with a hatchet rather than a scalpel.
This administration has lopped a trillion dollars from Medicaid due to last year’s Big Beautiful Bill, forcing hospitals to cut back on services, and forcing many rural facilities to close, and by cutting subsidies to the Affordable Care Act, causing an estimate 12% (about 2.6 million human beings) drop in enrollment based on early 2026 data, with about 1 in 10 prior enrollees becoming completely uninsured.
This is a disturbing development in the richest country in the world. We are failing our most needy citizens. Unless you believe that they are all lazy freeloading illegal immigrants. But then you believe that we have the hottest economy in the world (rather than just being on fire) and that affordability is a liberal hoax, just like they say on MAGA Pravda, aka Fox News.
And Medicare is next up for DOGE-like treatment if the House and Senate remain in GOP hands after the midterms. Trump recently announced the end of the Medicare Part D drug subsidy at the end of this year. This could mean higher drug premiums for millions of older and disabled people.
The Biden administration offered private insurers these subsidies to keep the prices for Medicare Part D (drug benefit) stable after the changes made by the Inflation Reduction Act of 2022 that made insurers pay a greater share of catastrophic drug costs. Before the IRA, the federal government paid the majority of those costs. Insurers planned to pass the costs on to the consumer but the Biden subsidies mitigated that. Trump’s Medicare officials are terminating that subsidy. Another contribution to tax breaks for the wealthiest of Americans.
This may be an effort to drive more Medicare patients into the private Medicare Advantage programs which are not affected by the subsidies. But the MA programs are the HMO version of Medicare, so they have more restrictive networks, meaning your choices of providers may be more limited and your doctor may not be covered.
The rest of the world somehow gets by with a less convoluted healthcare system that strives to provide necessary care for everyone. Wealthier countries also have a robust private system that provides whatever care the patient can privately afford. The key is that universal coverage is provided so that any person can get required care and not go broke in the process. But that is a topic for another day. Just remember to vote this November.
Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.
This article originally appeared on Ventura County Star: Trump administration undermines health insurance coverage | Dr. Loh
