Everything is becoming more unaffordable, but health care may lead this list!

A Mar 23, 2026 NY Times article, “When voters talk about ‘affordability’, many point to health care”, emphasizes how big a deal this is to the American people – and for those who consider this finer point -- American voters. Lots of things have been becoming increasingly unaffordable, so why should health care be different? Housing is ridiculous, and if you live in one of the larger cities in this country, it may well be out of reach. The Times had another piece the same day, “How a Family of 3 Lives on $500,000 on the Upper West Side”, and apparently it is not that easy. In most of America, a family of 3 making a half-million dollars a year, would be rich, but in New York City (and it is similar or worse in San Francisco, Boston, LA, San Diego, DC, etc.) you’re living in a one-bedroom apartment (near Central Park, though) and trying to save up for something bigger, made more difficult by the $4200/month you pay for childcare for your one-year-old, more than the $3900 yoy pay in rent. Doing the math, those two expenses come to less than $100K a year, so they should still have money left, but I guess other things cost a lot as well.

Food is another big issue; even more than housing it is a necessity (there are, sadly, too many unhoused people but no one can go too long without food) and it is a real issue. I had a friend who was from Colombia, and decades ago he observed that he could understand how people could be homeless in the US, but not hungry. Unlike in his country, where housing was cheap and food expensive, you could get a dozen eggs for $1. Well, recently in many places a dozen eggs were above $6. Whatever you think about eating meat, it has become a rare luxury for many families. And gas? Thanks to the US/Israeli attacks on Iran (I take a deep breath and don’t offer more comments) and Iran’s response, gas prices have shot up. I see articles about it being up 20-30%, but where I live in Tucson, AZ it was $2.79 before the attacks and in the same stations is now $4.45 or more (that is about a 60% increase!) The administration has also cut back incentives for non-gasoline cars as they want to push oil and gas – whoops! Since public transportation is so lousy in many places, people depend on cars to get around and get to work when they have a job.

So, with those 3 things – housing, food, and gas (4 if you add childcare) costing so much, it is pretty salient that the people in the Times article single out health care as a main concern about affordability. And, as I have often written, its unaffordability has been increasing and increasing and increasing. Health insurance premiums are up, and for those who receive it through their employers the percent that the employee must contribute is also up. Deductibles are up. Co-payments are up. And even when you pay all that – and frequently people cannot – you may well not get the care you need because insurance companies have ratcheted up their delay-and-deny game, hoping you will give up and not appeal when they deny you coverage for or require your doctor to get “prior authorization” for something you really need, keeping you away with algorithms that stymie your doctors. Or, maybe they completely deny payment because you went to the “wrong” hospital, one that is not in your (really, their) network. Maybe because you were, well, really sick!

Or you could have Medicaid and find that that, as bad as it was, is being cut. Or even more, is cutting you out entirely! Or you may have had health insurance that you could almost afford as an individual through the health insurance exchanges set up by ACA (Obamacare), but now find that subsidies have been cut and there is no way you can continue to afford it. Or maybe you live in a state that never expanded Medicaid (which was the way the ACA sought to cover those too “rich” for Medicaid but too poor to afford insurance on an exchange), and so you have been without access to care for years. Or, maybe are already dead.

Or you could have “traded in” your Medicare, a single-payer program for senior and some disabled people, for “Medicare Advantage”, an insurance company product that sounded great at the start but puts you right back in an HMO, where you have limited providers and the insurance company can deny you coverage. Or, just to be sure that we are not letting anyone out of being screwed, you can have opted for traditional Medicare and find out that the new WiSER program is allowing companies to use AI-based algorithms to deny care in 6 states (so far)!

Wendell Potter’s substack “Health Care Un-Covered” published With CVS’s Vertical Empire Under Threat in Tennessee, the Company Threatens to Leave on the same day (Mar 23) helps explain the reason. While the headline is somewhat optimistic (that the state of Tennessee is trying to reign them in) the real importance is the description of that vertical integration of CVS’ empire, in which they control not just local pharmacies and the health insurance giant Aetna, but also the pharmacy benefit manager (PBM), Caremark, which is now its largest cash cow! It’s a great deal for them, as they pay themselves, and have little competition from small agencies. They do have competition from UnitedHealth, which owns the PBM OptumRx and the provider group Optum, and CIGNA, which owns ExpressScripts, (which Potter explains Just Got Sued for Racketeering), so it is not an monopoly, just an oligopoly with a small number of players. And not one of those players is at all interested in your health. They are entirely focused on their bottom lines, as I discussed on Feb 26, 2026 in The problem with the US healthcare 'system': THE INSATIABLE PURSUIT OF EVER MORE MONEY BY CORPORATIONS AND WALL ST.  

The Times article emphasizes the political conflict between Republicans, who have been responsible for all the cuts and are trying to make it worse, acting exactly as if their goal is to hurt and kill lower-income people, and the Democrats who are trying (unsuccessfully so far) to block cuts to ACA and Medicaid, and perhaps place some limits on Medicare Advantage. But most “mainstream” (read “corporate”) Democrats are severely limiting their suggestions to, basically, returning to Obama-era goals. A significant minority of Democrats in both the House and Senate have signed on to cosponsor the Improved and Expanded Medicare for All bills that would move the US into the mainstream of healthcare in all wealthy countries by completely covering everyone for everything (see Yes, Rep. Van Drew, there IS a solution!,  Dec 30, 2025)! If that happened, the US would no longer be a standout for bad, paying 2-3 times what other countries pay and having worse health outcomes – and, as described above, moving in the wrong direction.

I don’t think that most Democrats are opposed to your receiving quality healthcare at a reasonable price (not sure about Republicans) but they get lots of money from these insurers, PBMs, and health systems. They need to hear from you!

Premiums are up, people are dying and insurance companies are making out like the bandits they are

In “Medical debt ruined her credit: 'It's like you're being punished for being sick'”, on NPR October 6, 2022, reporter Aneri Pattani covered the story of Penelope Wingard of Charlotte, NC, and others who had their credit ratings ruined as a result of the cost of medical care. This is bad, but is not as bad as the fact that they could no longer receive medical care. Wingard tells the reporter that "My hair hadn't even grown back from chemo, and I couldn't see my oncologist." After all, the doctors and hospitals want to be paid. In response to pressure from breast cancer advocacy groups, North Carolina had passed a law that temporarily granted Medicaid to breast cancer patients like Ms. Wingard. But then it ran out. As did her money. And her medical treatment. And her credit score plummeted.

What is the worst part of this story? For Ms. Wingard, it is both that she is broke and has no credit, and that she can no longer get treatment for her cancer. For many of the rest of us, it may be that something like that could happen to us or someone we love. For all of us, it is the remarkable fact that we find it unremarkable, that someone could go broke from their medical bills and lose their ability to buy necessary things on credit, and then not even be able to get their needed medical care. It is just the way it is, we think. Awful, and it happens all the time.

Except it is not just the “way it is”. Only here. It is not this way in any other wealthy, or most middle-income, countries. They all have universal health insurance that covers everyone for medically necessary care. Mostly they have had it for many decades. What is remarkable to most people in those countries is that we could possibly think that such a thing is unremarkable, if not exactly “OK”, is the “way it is”, and we are willing to tolerate it. This was the message from the PBS documentary by T. R. Reid “Sick Around the World”, aired in 2008, and covered by me, along with its 2009 follow-up “Sick Around America”, in ‘"Sick Around America": A little bit sickening’, August 5, 2009. In the earlier show, Reid interviews political and health leaders in 6 countries and asks, among other things, how many people in their country go bankrupt from medical debt. In that post, I quote the then-president of Switzerland, ‘a conservative who had originally opposed the Swiss program in the early 90s. “No one,” he boomed in his French-accented English, “why, it would be a national scandal!”‘ Then, and now as we approach the end of 2022, it should be one in the US, and yet we get stories like those of Ms. Wingard. These issues affect many Americans, and as usual are worst for those who are most disadvantaged.

It is “the way it is” in the US because we have chosen to make it so. Actually, it is our politicians who have chosen to make it so, blocking any effort to implement a universal health insurance program, from the 1920s to the time of Harry Truman in the late 1940s (when the AMA was the big opponent), to the 1960s when Medicare and Medicaid were passed and seen as the forerunners of such a program, to the current day. Why? Because of the powerful interests of those who are making money off our current health system, insurance companies and hospitals and other delivery systems (often vertically integrated) and pharmaceutical and device makers, who give lots of money to politicians and wield a lot of clout. They are not only making lots of money in an ostensible “free market” system, but in particular from government programs that they collect public money from. Don’t buy the false idea that “privatization” reduces costs; “administrative costs” are <3% in traditional “government” Medicare but upwards of 15-20% in Medicare Advantage. What privatization does is increase profit!

And, not content with making a lot from Medicare Advantage (a private, for-profit operation that our politicians should not allow to use the name “Medicare” – indeed, there is a bill in Congress now to prevent it – write your representative!), they further game the system by “upcoding”, paying folks whose job it is to make sure that every potential diagnosis and complication is recorded to maximize the amount of (your tax dollar) money that they collect from Medicare. Sometimes this is legal, if outrageous, but insurers are certainly not unwilling to push the legal envelope for more money (‘Cigna received millions of Medicare dollars based on invalid diagnoses, lawsuit claims’, ABC News October 17, 2022 -- and ‘millions’ is an underestimate). And it is assuredly not just Cigna that is guilty; while insurance premiums for Americans have increased 200% in the last decade, United HealthCare last year reported $24B ($24,000,000,000) in profit, more than ever before, an obscene amount, and a completely unabashed example of the fact that what is called the “healthcare” industry in the US is just an enormous profit center for the corporations that control it.

You want to know why we spend 2-3 times as much as any other wealthy country on “healthcare” and yet have so much poorer outcomes, shorter life expectancy, greater infant mortality, higher rates of “deaths of despair”? (‘Mirror, Mirror 2021: Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries’, Commonwealth Fund). This is the reason: the money is going to corporate profit, not your health care! If it were going to your healthcare, our outcomes would be better. But then they would not be making so much money, and donating so much of it to our (or maybe it is “their”) politicians.

Oh, maybe you thought that was the end. That insurance companies are raising our premiums, denying needed healthcare to sick people, making billions of dollars in profit, and corrupting our political system to ensure that it continues, was bad enough. And convincing you to shrug your shoulders and think “it’s sad, but that’s the way it is” when someone gets very sick, maybe dies, and goes bankrupt in the process. But, you know, that’s not enough for them. There is one more step: convincing you – and probably more important, the politicians – that it is not their fault that US health care costs so much. It is not the $24B in profit made by United. It is not the scamming of Medicare done by Cigna, or the entire Medicare Advantage and Direct Contracting Entities (DCE) programs that funnel public money into their pockets. No, no, it is YOU! As Wendell Potter, a “reformed’ health insurance executive, reports in ‘Corporate health insurance consultants blame high medical costs on our "bad habits" and "overuse" of system’ they say it is OUR fault for using too much care. Like, you know, going to the emergency room with chest pain, and sometimes it isn’t a heart attack (bad you!). Or, like Ms. Wingard, wanting to be treated for cancer. Or maybe even going to the emergency room when we are only sick, not dying, because we can’t get an appointment for the doctor.

It's not true, by the way. Europeans are hospitalized more frequently, have longer lengths of stay, and use the doctors at least as often. Their outcomes are better, especially when the health of the entire society is considered (we have a way of fudging this by only considering those people who were actually able to get care), and they pay a lot less. No, it is the profit and “administrative costs” of the health insurance companies and healthcare corporations.

Apparently buying into the idea of “incrementalism”, our politicians for the last 60 years have given us limited programs to help limited groups of people, at least somewhat. Seniors, disabled people, sometimes children, sometimes programs like the North Carolina one that paid for Ms. Wingard’s cancer treatment specifically because it was breast cancer (until, of course, it didn’t). This is NOT the way to go to get universal health care. The ACA (Obamacare) included the option for states to expand Medicaid to the less-than-desperately-poor and some did and folks in the other states are getting sick and dying.

No. We need a universal, comprehensive, EVERYBODY in, NOBODY out, health insurance system, government run or tightly regulated so there are not obscene profits. Like improved and expanded Medicare for All. Now.