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!

The greatest quality deficit? Physically destroying the health care system, and, oh yeah, the people it is supposed to serve

I have previously quoted from the important JAMA paper by Schiff, Bindman, and Brennan “A Better Quality Alternative: Single Payer National Health System Reform” (JAMA Sept 14, 1994, 272(10):803-808) the observation that “denial of care” is the “gravest of quality deficits”. It is generally hard to argue with this; if people are denied care they are not going to get quality care. While it can be argued that there are some forms of care that is worse than no care, this is clearly not what the authors have in mind. They are talking about the fact that people are denied appropriate care because they do not have money or insurance. More than 30 years later this still rings true, in an America that has not yet seen a health insurance system that covers everyone, as every other well-to-do country has, and indeed is even more threatened by cuts in the coverage that we do have. As I write, the federal government is facing a shutdown, with the Democrats in Congress demanding continued funding for those who received coverage from the expansion of Medicaid under the Affordable Care Act (ACA, “Obamacare”) of 2010, while the administration and Congressional Republicans steadfastly refuse to consider this, arguing mainly the high cost. This demonstrates once again their complete inhumanity and heartlessness, in no small part because earlier this year they cut more than that from the taxes of billionaires.

There are many ways to deny care, and rolling back Medicaid expansion is one. Another is closing hospitals, and many, mainly rural, hospitals, have and will close as a result of these cuts. They can also make existing insurance harder to get and more expensive, as is regularly documented in Wendell Potter’s substack “Health Care Un-Covered” and many other venues. I will talk more about this in a future blog post. But another, really effective, way to decrease access is to destroy health care facilities. Much more efficient than starving hospitals for money by discriminatory, greed-focused funding is actively blowing them up, killing the providers, and eliminating the infrastructure for providing care for anyone, insured or not. This is commonly done during a process called “war”, in which a strategy often adopted goes beyond violating the Geneva Conventions by not caring for enemy combatants, but indeed targets the elimination of the civilian health care infrastructure. The Geneva Conventions provide for not attacking health care providers, for caring for the wounded based on need, not loyalty, and certainly respecting civilian health care (some references: Rule 25 on medical providers, International Committee on the Red Cross, World Medical Association, Wikipedia (Medical Neutrality), among many others). I learned about much of this decades ago from a surgeon who worked for the International Committee on the Red Cross (ICRC) and HAD supervised one of its hospitals in Chechnya during the war there. It was this hospital which military combatants invaded, murdering four nurses. At the time, it was horrifying. Since then, such actions have become so common a practice in the 21^st century that, in itself, it almost refutes the idea that human beings have become more civilized over time.

While there are many places where combatants have used attacks on the civilian population and their health care facilities as methods of imposing their will, the attacks by the government of Israel on the healthcare facilities in Gaza stand out in their extent, persistence in the face of world opinion, lack of any sign of conscience, and contribution to genocide. I am not expert in war, but I know that you are supposed to try to not kill civilian noncombatants, and that you are not supposed to destroy medical infrastructure; these are war crimes. In Gaza both are happening; people’s houses and cities are bombed, thousands have been killed, hundreds of thousands displaced, and the facilities where they might go for care – for problems that occur in peacetime, of course, but far more for those inflicted on them by the military attack on them – are destroyed. On purpose. Repeatedly. As part of an immoral and illegal strategy to “win”, by killing or injuring as many as possible.

Israel, unsurprisingly, and its US supporters in the American Jewish Committee, deny this. They say that what they are doing in Gaza is not genocide, and that what they are doing in killing the people of Gaza as well as destroying its hospitals and other health care facilities and healthcare workers are not war crimes. Of course, what is happening is happening, but they are picking apart word, like the application of a particular term (“genocide”, “war crime”). I am also no expert on the definition of genocide (like, what percent of a group do you have to be trying to kill for it to qualify), but those who are most expert say that what Israel is doing in Gaza is genocide. No responsible independent body has even tried to justify what they are doing. The argument cannot be that “because we are Israel, what we are doing is ok, although it would be intolerable if anyone else did it especially to us”. Nor can it be that “no matter what we do, no matter how horrific or destructive, because we are a Jewish state, any opposition to it is anti-Semitism.” Of course, this position is without logic.

There can be no justification for the Holocaust, for any reason, for anyone. But just as the atrocities being committed by Israel do not mean “Hitler was right”, the fact that the Holocaust happened – and that there is serious anti-Semitism in the world today – does not justify those atrocities being committed by Israel. In true fascist tradition, the government of Israel is not only committing these atrocities, destruction of healthcare infrastructure and healthcare workers, killing civilians including children en masse and starving them, it is blocking international aid from coming to the people of Gaza. These flotillas of boats bringing aid, contrary to what Israel says, are humanitarian and the people doing it are brave and noble. The government of Israel, and those Israelis and non-Israelis who support its actions, are … not. Interested in knowing what is happening in Gaza? There are many sources, but here is a recent article from the NY Times, longstanding Israel supporter on the destruction of Gaza. Or how about the video, if you need visual evidence.

There are terrible threats to the health of the American people, longstanding and persistent threats from greedy and evil for-profit insurers and pharmaceutical manufacturers and PBMs and health systems and private equity. These have been exacerbated by the Trump administration’s hostility to covering all people, such as the cutbacks in Medicaid expansion from the ACA, an issue on which the Democrats have finally shown some spine although the GOP commitment to not spending the money in order to maintain tax cuts for the wealthiest has led to a federal government shutdown. It is a very bad situation for many Americans, especially those with the greatest vulnerability.

But this is almost nothing compared to the attacks on health in many places, and particularly in Gaza. The purposeful destruction of cities where people live, mass murder of civilians, huge displacements of people, augmented by the destruction of the very facilities that might provide some treatment and succor, is without conceivable justification.

The authors of the paper cited at the beginning of this piece were, thus, not correct in saying that lack of access is the greatest quality deficit. That is true when there is a functioning health system and some people are excluded. Actively doing what is done in many wars, and what Israel is doing in Gaza, is a much worse assault on not just quality of healthcare but on health and life itself.

Guns good? Depends on what you believe. Guns dangerous? No question.

People like guns.

People hate guns.

People are scared of guns.

Guns are good for sport, like hunting animals.

Guns are good for war.

Guns are good for self-protection, in case “they” come for you.

Guns are good for going out and killing other people because:

·        They might otherwise come for you.

·        They are bad people because they are:

o   The wrong religion.

o   The wrong race or ethnicity.

o   Believe in abortion.

o   Are liberals.

o   Support restrictions on guns.

Guns are bad because they can be and are used for all of the reasons above.

Whether guns or good or bad or dangerous or not is irrelevant because “Second Amendment”.

If you like, substitute “automatic rifles” for guns in all or any of the above.

All the above are true.

There are definitely people who are terrified that “they” will be coming for them.  “They” could be the government (except when the government is on their side), or they could be, you know, “them”, the other.

Probably not for deer hunting; 30 or 40 rounds of high-power automatic rifle fire can really tear up the meat.

It could be post-apocalyptic, where they are, like Mad Max, fighting for survival. They believe that they need thousands of rounds of ammunition for all their guns (after all, ammo stores might not be open after the apocalypse) and high-capacity, high-speed automatic weapons are going to be more effective in protecting themselves and their families from, well, whatever.

Zombies. Or “them”.

If you believe this stuff, and your social circle and the sites that you frequent on the Internet completely reinforce these beliefs, there is no reason to doubt that it is true. Even if you used to not believe them. (Remember, perfectly rational people from the Midwest have moved to California and, after some time being among only Californians, have come to think that it is normative to believe in the healing power of crystals.)

If you do not believe this stuff, and your social circle and the sites that you frequent on the Internet completely reinforce your non-belief, you become convinced that the folks that do are both crazy and deluded. Which they may be.

If you think that these people watch too many movies and zombie TV shows, you’re right; the most important FACT is that there will be a much more limited number of people who are alive to duke it out after a nuclear war; let’s see, after nuclear winter, roughly ZERO!

If you think that there is a certain cognitive dissonance in thinking that people on the left are pansy snowflakes and also fearing that they’ll be coming after the heavily armed folks with the fears, you’re right, but so what?

Total logical contradictions have never been a problem for them in the past (see, e.g., “Donald Trump – Christian”).

There are a lot of folks in the “I need more guns and ammo” camp who are strongly opposed to mass murder, although there are pretty many (including in Congress) who are able to make arguments (sure, weird syllogisms, but hey…) defending folks who go to peaceful demonstrations with loaded weapons looking for other people to shoot. Charlottesville? Kenosha?

It is a “prevent defense”, I guess. There are even more who are opposed to slaughtering children in school (hardly anyone comes out specifically in favor of that), but are 100% against any proposal that might make it more unlikely.

Because, you know, if you make psychotic minors unable to purchase an AR-15 without a waiting period, the next thing will be government agents confiscating your deer rifle. Or Uzi.

No one is in favor of school shootings, but we have them almost every day. In every state. We look at the news, open the paper, hear our phones ding, and we see the newest one. And our Congress, and our state legislatures, all of whom are against school shootings, can’t seem to do anything to prevent them. Even though we – and they – know exactly what would do it.

Make guns very hard to get. Especially for young people. The brain does not fully mature until at least the mid-20s and the last part to develop is the frontal cortex where executive function and judgement reside.

Especially for automatic weapons.  Especially with those with histories of violence. Yes, crazies but mainly not them. Mostly those who have or have threatened to use violence. You see, shooting people, especially lots of people, that may or may not be crazy, but it is for sure violence. Any abuser of any kind, any barroom brawler, anyone who threatens violence.

But of course they won’t. Maybe because it would lose them votes, or maybe they just believe the same things. Maybe they believe their own stories.

But, you know, you can kill people with a knife. Or a baseball bat. Or a garotte. Of course, it is not easy to kill a whole lot of people from 100 feet away with any of those.

I would be remiss to not mention suicide. They constitute the majority of gun deaths. Yes, suicide is an individual’s choice, but it is not necessarily an unchangeable choice. The “successful” suicide rate among teens and young adult males 16-24 is TEN TIMES higher in the states with the loosest gun laws as in those with the most restrictive. Are young men in, say, Montana more depressed than those in, say, Connecticut? I don’t know, but suicide attempts, especially in young people, are very often impulsive, and the easy availability of a gun makes that impulse easier to follow. And attempts at suicide by gun are much more likely to be “successful” (called lethality) than those by poison, or gas, or hitting yourself on the head with  brick. 

In the US it is often people in poor and minority communities who suffer the most random death. But it is older white men who commit suicide most. Often with guns that they had right there.

If you think we should make guns, especially automatic weapons, less easily available, especially to those most likely to use them for killing people, great. But lots of others do not agree. Of course, they include those most likely to use them for killing people.

 

The rest of the wealthy world could provide an example of what to do, but you know what? They are not Americans. A number of countries have higher gun-death rates than the US, mostly those at war (e.g., Ukraine) or in the midst of narco terrorism. We are not.

But we have a lot of guns, and that helps us make up the difference.