I started this column earlier in the week while I was being treated in the intensive care unit at UPMC hospital in Pittsburgh. Fixing some of those things that need to be fixed gets tougher as you get older, but I am back on track now because I am a very lucky American.
I have been blessed with a principled employer who provides affordable healthcare. I live in a town that has exceptional hospitals and medical facilities. And we attract the smartest doctors, nurses and staff, because we have teaching hospitals.
Staring at the ceiling this week gave me time to count all those blessings. It also drove home the fact that in the richest nation in the world — this land of plenty — many Americans do not have affordable healthcare, and their current government has been actively trying to keep them from getting it.
For many decades, presidents of the United States from both political parties have tried to make healthcare more available. Harry Truman said the greatest failure of his administration was not getting national healthcare, but he did pass some legislation that helped.
Lyndon Johnson made historic progress with the passage of Medicaid and Medicare. Richard Nixon expanded that coverage and had a plan that would cap catastrophic healthcare costs — insuring Americans against the worst that could happen — but Watergate ended that.
Finally, Barack Obama got Congress to pass sweeping healthcare reforms in 2010, insuring nearly 24 million more Americans by 2016. It cut costs, expanded coverage, eliminated disqualifying “pre-existing conditions” and covered our children until age 26 — all while reducing the budget deficit.
The plan was not perfect, but it has extended and improved millions of lives. Formally called the Affordable Care Act (ACA), it is commonly called Obamacare, and that may be part of why Donald Trump has continuously targeted it.
Trump tried to kill the ACA and strip away our fellow Americans new coverage in 2017. Republican Sen. John McCain stopped him with his famous “thumbs-down” vote. But Trump has stayed at it — sneakily.
Since he has not been able to outright kill the popular program — a 2025 Gallup poll showed 57% support — he has opted for “death by a thousand cuts” by changing the rules.
High-deductible plans with low monthly payments are a Trump shell game. Thom Walsh recently wrote for The American Prospect that they “become unaffordable at the moment of illness, injury, pregnancy or diagnosis — the kinds of things we need health insurance for.” Then you must pay out of pocket, and the price is so high that you can’t pay.
Early indications are that enrollees will have declined from 22.3 million last year to 16.5 million this year. And the White House announced another new rule for 2027 to cause further decline.
Michael Hiltzik described the coming cruelty in his LA Times column last week, “GOP attack on Obamacare: Worst is yet to come.”
The new rule “undermines program integrity, eliminates key consumer protections, forces consumers into choices that are not to their benefit and saddles states with higher costs.”
In what sounds like a nod to Trump’s grip on his party, Hiltzik wrote, “For some reason, the fear that more will be done to make American healthcare more accessible, affordable, efficacious and humane grips Republican hearts. Go figure.”
But this is America, and Harry Truman said it right in 1947.
“Healthy citizens constitute our greatest natural resource … as a nation we should not reserve good health and long productive life for the well-to-do, only, but should strive to make good health equally available to all citizens.”