The Administration's Three-Pronged Assault on Health Care

I wish I could offer a link to an outstanding article in the current NY Review of Books entitled "The Dismantling of American Health Care," by Adam Gaffney, David U. Himmelstein, and Steffie Woolhandler.* It's the best (and most depressing) summary of the damage the Trump administration has already inflicted in three critical spheres of the country's health care matrix: 

The three fronts of this assault—on tax-funded medical coverage, public health, and medical research—have overlapping aims. The campaign to slash Medicaid—relied on by the poor since its establishment in 1965—follows a long neoliberal tradition of prescribing austerity for the working class and largesse for the rich. Trump and his allies seem to view public health, for its part, as waste that can be excised (DOGE-style) to fund tax cuts, as a source of regulatory excess that constrains profit-making, and as a locus of “woke” ideology and inconvenient facts. The assault on medical research is driven by similar concerns, with the added benefit of dominating rival centers of power like universities and the professions.

 The cuts to Medicaid and Medicare are incredibly short-sighted and cruel. The cuts to medical research are bound to lead to increases in morbidity and mortality. And the cuts to public health initiatives is particularly foolish. The authors write: 

This funding squeeze is without historical parallel. Yet it also bears stressing that public health agencies have long been underfunded and neglected. Unlike medical care—which almost everyone periodically encounters when they go to a doctor or an emergency room—the equally essential work of public health is often invisible. Americans’ life expectancy soared by more than twenty years in the first half of the twentieth century, mainly owing to public health measures like safe drinking water, rather than to improvements in medical care. In more recent decades public health measures, like those that decreased air pollution and smoking, have been responsible for about half of life expectancy gains.

For all that, public health initiatives have been historically underfunded. As a component of overall health expenditures, it's accounted for 3 percent in 2024:

 Gutting public-health infrastructure and programs puts barely a dent in the projected deficits of the One Big Beautiful Act bill,** So something else is going on here. 

Trump and his MAGA supporters fervently believe that the federal (and some state) public health authorities -- CDC: They are talking about you -- overplayed their hands during COVID: too many mandates (vaccines, masks) and not enough individual choice. This ignores at least two points: (1) public health is the antithesis of autonomy and self-determination,; it prioritizes community health over individual choice -- always has and always will, and (2) the mandates probably saved hundreds of thousands if not millions of lives. Were they onerous? Burdensome? Possibly broader than they needed to be? Yes, yes, and maybe. But taking funds away from research and public health initiatives, not to mention Medicare and Medicaid, is a gross overreaction to the 2020-24 response to COVID. And down the road we will all pay the price for this woefully benighted policy.

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* Contact me offline for a PDF of the article, which I share solely for the purpose encouraging you to subscribe to this outstanding publication.

** No longer the official name of the law signed by the president on July 4 (here).