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!

Lead poisoning of our children: then and now

Back in 2016 much of the country was shocked to learn about widespread lead poisoning among children in Flint, MI. The cause was lead leached from old lead pipes supplying water to people’s homes after the source was changed from Lake Huron to the more corrosive water of the Flint River (to save money, of course). The identification of this problem was largely due to the great work of a committed pediatrician, Dr. Mona Hanna-Attisha, about whom I wrote on Jan 24, 2016, “Flint, lead, medical heroes, O-rings and guns”. That piece also discusses the shameful – probably criminal – denial of both the problem and its cause by the then-governor of Michigan, Rick Snyder, and his politically appointed state health department, until the evidence became too overwhelming to deny. After all, poisoning children is one thing, but getting negative press is another!

Many of us probably assumed – or at least hoped – that this epidemic of lead poisoning of children, as horrible as it was, was an exception, an outlier, something that should not be happening in the 21^st century in the United States. We knew that it was related to the fact that Flint is a poor, largely minority, community, and if we are at all sentient we know that those are the people who suffer the worst from environmental degradation. In the case of lead poisoning, they live in houses that are more likely to have old lead paint, in neighborhoods built closer to heavy automobile and truck traffic areas where the soil (such as, for example, in the playgrounds) has high concentrations of lead. We might have even thought of lead pipes supplying water. But surely this was not something that was happening in many places around the country, even in poor communities?

 

But it was, and is. All over. More in very poor and minority communities.

A few years ago, [Sean] Ryan, now a Democratic state senator, learned that his constituents in Buffalo were sending bottled water to Flint, Mich., where widespread lead contamination in the water supply had drawn national attention. While respecting the gesture to help, he recalled from a Reuters investigation that there were 17 ZIP codes in Buffalo where the rate of children with high lead levels was at least double that of Flint. (Gabler, NY Times, below)

And it is still happening. And still not being addressed. Flint may have stood out because of the sudden increase in children with high lead levels identified by people like Dr. Hanna-Attisha after the change in water to a cheaper source leached lead from the old pipes, but chronic, ongoing lead poisoning of our children, primarily from lead paint in old houses, continues apace. And there is a lot of resistance to doing anything about it.

 

This is covered in depth in a recent (Mar 29, 2022) article in the NY Times by Ellen Gabler, ”How 2 Industries Stymied Justice for Young Lead Paint Victims”. This exposé documents the ongoing and continuing poisoning of America’s children (particularly those of poor and minority people) by lead paint in houses (“about 500,000 children under 6 have elevated blood lead levels in the United States and are at risk of harm”). One of the two industries is the housing industry, which both lies about whether there is lead paint in the homes that they are renting, and, if they are large enough, obstruct those people from finding some sort of (generally financial) justice by hiding the ownership in a web of companies, and fighting culpability.

 

Without insurance, there is little chance of recovering money for a child when a landlord has few resources. Property owners who do have substantial holdings have found ways to legally distance themselves from problem rentals, increasingly using L.L.C.s to hide assets and identities.

 

And the other industry? That would be the insurance industry itself, which places clauses in its homeowner’s policy excluding lead. Why? Well, you see, it would cost the insurance company a lot of money if they had to pay for the mitigation of lead paint in these old houses. So they don’t insure the owners, and the owners are either unable to afford to do the mitigation or are large and wealthy enough that they could afford it but choose not to. In fairness, the quote above about property owners legally distancing themselves from “problem rentals” applies to many “problems” (virtually all of which are the owners’ responsibility), not just lead. Property owners want to collect rent but not maintain the property; insurance companies want to collect premiums but not pay out when there is a problem. What could be more American?

 

Another recent article, in Medscape, documents how most current adults had elevated lead levels as children, and how, as stated in its title, Half of Adults Lost IQ Points to Lead Toxicity. The culprit in this case is primarily lead in gasoline. Added to gasoline beginning in the early 1920s, lead’s phaseout was accelerated by the advent of catalytic converters, which require unleaded gas, in 1975, but it was probably an additional 20 years before it was gone from most gasoline sold.  And, of course, the residual lead in the soil (including places where children play) remains even today. This graphic from the article demonstrates how ubiquitous high lead levels were when today’s adults were children, what age ranges are most affected, and of course how minority children (and today’s adults) were affected with levels far higher than whites (which were bad enough).

 

 

So we have a situation where the majority of today’s adults, at lead those over the age of 30, probably had high lead levels when they were children, and have lost IQ points as a result, and where poor and minority children then (now adults) had far higher levels than whites. And we have another situation in which children continue to have high lead levels, and to suffer not “just” a loss of a few IQ points but serious brain damage, because of ongoing lead exposure, now primarily in lead paint that still exists, unmitigated, in many houses. And, of course, these children are disproportionately poor and minority. (Some things, sadly, do not change.) When I was a young physician, working at Cook County Hospital in Chicago, we would not infrequently have to treat (often as inpatients) children with high lead levels. I thought, like measles and chicken pox and rheumatic fever and infections from Hemophilus influenza that this was pretty much history, stories of the “old days” that I could tell medical students and young doctors. I am aghast to discover how common it continues to be.

 

But there is another part of the story. It is that lead could be cleaned up. Houses with lead paint could have that lead mitigated. If it were, children would no longer be exposed to it and suffer the kind of brain damage described in the Times article. But it isn’t happening, because of the stonewalling, opposition, and outright blockage by the landlord and insurance industries, and their enablers in Congress and state legislatures. Their profits, of course, are more important than the brains of developing children, especially poor and minority children.

 

You can’t have it both ways — be a big company when it benefits you to generate revenue and business, and then hide behind an L.L.C. when you are sued in an attempt to escape accountability

 

says the attorney for “JJ”, a South Bend, IN, child with brain damage from lead paint in his home.

 

But they do have it both ways – this is how the US treats companies compared to children. And as a result we have the article’s final quote from JJ’s mother:

 

“We know it damaged his brain,” she said. “We know it is irreversible. And we know it is a lifelong thing. No doctor can tell you, ‘This is what is going to be.’”

 

Somehow, this does not make me proud.