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!

A majority of Americans are worried about health care costs -- and a majority of Congress doesn't care

People in the US are worried about a lot of things, but apparently the top one is whether, and how, they are going to be able to pay unexpected medical bills. The chart below, based on an August, 2018 survey, is provided by Drew Altman, President of the Kaiser Family Foundation, in the September 24 Axios. Indeed, concern about medically-related costs come in not only as #1, but as #2 (health insurance deductible), #4 (prescription drugs), and #6 (monthly health insurance premium), making up 4 of the top 8 concerns, all of them ahead of “rent or mortgage” (#7) and “food” (#8). All 8 of these concerns are upsetting; it is outrageous that over one-third (37%) of Americans are very or somewhat worried about being able to afford food, or 41% rent or mortgage. But a twice as many people, two-thirds, 67%, are very or somewhat worried about being able to afford unexpected medical bills, and over half (53%) about their health insurance deductibles.

 Of course, those who are worried are not evenly distributed among all Americans. They are not the suburban men who are turning more toward Trump, as they sit on the golf course by their $500,000 homes. They are certainly not the people in power in Washington, whether in the administration like Jared Kushner, who pays no income tax, or his father-in-law, President Trump, who has not released his tax returns, or the senators and even congressmen who make policy, or the members of the Supreme Court.

They certainly do include the poor, including many who are members of minority groups; those who, even in the best of circumstances are barely hanging in there – or often are not. These are the folks for whom paying for housing and food is an all-consuming concern, who do not know where their next meal may be coming from. For them, extraordinary medical bills are not even something that they can spend time worrying about, although they would certainly not be able to afford them.

Those worried, however, also include the large percentage of Americans (see the numbers) who are not poor, but are not all that far from it, people who are not that many paychecks from homelessness (a good measure of real risk). These are people who do not qualify for Medicaid (especially in the states that have not expanded it under the ACA), do not yet qualify for Medicare (and even many of those who do), and who often have health insurance either through their employers or through the ACA marketplaces. The employer health plans, overall, are cutting back on benefits, increasing employee contributions (#6), requiring higher deductibles (#2), and even instituting lifetime caps on benefits as well as excluding many times of illnesses. Fortunately for these people, the ACA has important requirements that help protect them: that people with “pre-existing” conditions be eligible for health insurance (without that, many folks with chronic disease would not be covered), and that there be “community rating”, which means insurance companies can’t charge individuals with particular conditions many times more than they charge others (without which most folks wouldn’t be able to afford the premiums).

It is also true that the current administration and Congress have been trying very hard to limit, when they cannot repeal, these very protections that provide a minimum safety net for most Americans. They are also keeping up a drumbeat about the “cost” of programs such as Medicaid (it’s just poor people, after all, except it is also your elderly parents and grandparents in nursing homes, and this is the bulk of the cost), Medicare (a bit of a “third rail” in politics, but which lots of Republicans keep bringing up as needing to have its benefits cut), and even Social Security, the program that keeps many, many American seniors from being in real poverty even as it continues them in near-poverty. The fear of losing insurance because of having a pre-existing condition is, scarily described by Kurt Eichenwald in a NY Times Op-Ed on October 16, 2018.

The fear of #1, “unexpected medical expenses” is, I assume, primarily about getting sick when you weren’t planning on it. Most folks are not hoping to get sick, but for some the exposure is particularly great because part of the way they handle #6, monthly health insurance premiums, and #2, high deductibles, is not be either uninsured or poorly insured. The latter is particularly common, both in many employer plans and even in ACA individual plans. Indeed, while they call it something different (“free choice” and “granting Americans the freedom to buy health care across state lines”[1]), the administration and Congress are actively encouraging high-deductible, low-coverage policies. This makes premiums seem affordable (or more affordable), but is a disaster when someone gets sick (back to #1).

In addition, limited networks are a quicksand trap for many people, who try to carefully go to doctors and hospitals that are in their networks, only to find themselves faced with huge bills from emergency room physicians, specialists, surgical assistants, and lab and imaging services that are not. This is truly a kind of “gotcha”, a quicksand trap. It is unbelievable; or maybe it is too believable. What may be more unbelievable, to many Americans, is that in most other developed countries health care systems are designed to serve people’s health, not trick and bait-and-switch for the purpose of corporate profit.

Medicare, as currently structured, is not a panacea; 31% of US seniors go without health care because of cost. But it is much better than nothing, and could be really good if it was better funded, and for-profit insurers were not skimming the “cream” (the least sick) into Medicare Advantage plans (which have much higher overhead/administrative costs than traditional Medicare).

Sadly, the issue of whether Americans should have adequate and affordable health care has become highly partisan. This is in some part because at least a portion of the Democratic Party has moved to positions in support of health care as a right, and a universal health insurance system (such as Medicare for all). But it is much more because the Republican Party has moved into complete opposition to any plan to expand health coverage to more Americans (e.g., Medicaid expansion, ACA) and is actively and aggressively moving to cut funding for ACA, for CHIP, for Medicaid, and even for Medicare (“we can’t afford it” is the stated reason, although it really means “we can’t afford it while giving multi-trillion-dollar tax cuts to corporations and the wealthiest”).

Sadder is the fact that many of those most affected, many of those with the greatest worries about health costs, whether unexpected illness, high deductibles, high prescription drug costs, high premiums, are reliable Republican voters. The Associated Press published a piece describing how the Democrats are focusing on health care for the midterm elections, citing the senate race in my state, Arizona. It describes how the Republican candidate, Martha McSally (currently my congressperson) tries to talk with business executives about the tax cuts but is regularly interrupted with questions about health care:

‘They are asking about Democratic ads saying McSally, currently a congresswoman, supported legislation removing the requirement that insurers cover people with pre-existing medical conditions.

"It's a lie," McSally said quickly, accustomed to having to interrupt a discussion of the tax cut to parry attacks on health care. But she had voted for a wide-ranging bill that would have, among other things, undermined protections for people with pre-existing conditions and drastically changed and shrunk Medicaid.’

Actually, then, it is she who is lying. Hopefully she, and other GOP legislators, will pay a price because people vote for those who are actually trying to solve their health care problems, regardless of party. We can hope that more and more Americans will, at least on this important issue, stop voting against their own interests.

I hope.

[1] This is actually the phrase used in the “survey” – completely non-scientific and filled with leading or directive questions – that Trump sends out to his supporters.