The final blow to American healthcare

In early July, Congress passed Trump’s “Big Beautiful Bill” (OBBBA) and signed it into law. An extension of his 2017 tax cuts, the bill represents one of the largest wealth transfers in recent memory. The upper class will enjoy enormous tax breaks, funded through the slashing of Medicaid, SNAP and other social services. To compound the injustice, those cuts will also bankroll the expansion of ICE and border security. The Congressional Budget Office estimates the law will add $3.4 trillion to the deficit over the next decade.

Despite mounting concerns about ballooning deficits, the wealthy and corporations have emerged as the clear winners. The House Committee on the Budget reports that those making more than $500,000 will receive an average tax cut of $47,000—$12,000 more than they received under Trump’s initial 2017 Tax Cuts and Jobs Act (TCJA). By 2027, Americans earning over $1 million annually will see their tax burden fall by $97,000. In its first year alone, the TCJA transferred $37 billion to millionaires. The new law is set to transfer an astonishing $114 billion to that same group.

The redistribution of wealth upward is staggering, yet much of the political commentary has focused on a different provision: the law’s expansion of ICE. OBBBA allocates $46.5 billion for border wall construction, $45 billion to expand detention centers, and $30 billion to hire, train and equip ICE agents. Immigration experts estimate ICE’s budget will triple, reaching $27 billion annually through 2029. The agency has already signed lucrative contracts with private prison companies such as CoreCivic and GEO Group. Recent public deportations have reinforced the sense of a society tilting toward authoritarianism.

The systemic empowerment of ICE represents a dangerous turn toward genuine fascism. Yet the dismantling of the American healthcare system is not a new development, but the result of a decades-long historical project, revealing the fundamental inequalities at the heart of American society. The CBO projects that OBBBA will cut federal medical spending by $715 billion over the next decade, $625 billion of which comes directly from Medicaid. As a result, 11.8 million Americans are expected to lose coverage. The majority will not receive health insurance through their employers, leaving them uninsured.

This will deepen an already dire crisis of medical debt in the United States. Over 20 million adults currently owe money to a healthcare provider. That figure soars to 107 million when factoring in adults who carry credit card debt related to medical costs. Of these, 44 percent owe more than $2,500, and 12 percent owe more than $10,000. In the last five years alone, medical debt has made up 58 percent of all debts sent to collections and has been the leading cause of personal bankruptcy. Beyond financial devastation, such debt drags down credit scores, making it harder to secure housing, car loans, or even basic employment.

OBBBA will accelerate this crisis, but it is not the root cause. Rather, it is the culmination of a decades-long bipartisan failure to secure universal healthcare.

In 1960, economist Friedrich Hayek published “The Constitution of Liberty.” The book serves as the intellectual foundation of neoliberalism, and thus for the American healthcare system. Hayek rejected the notion of universal human rights, including healthcare. Citizens, Hayek argued, are consumers who should exercise economic freedom by purchasing as much—or as little—healthcare as they desire. This market logic eventually seeped into U.S. politics, shaping both Republican and Democratic policy.

During the 1960s, however, Americans were open to the idea of a social-democratic healthcare plan. Following Lyndon Johnson’s election in 1964, Democrats passed legislation establishing Medicare and Medicaid. Many on the left saw these programs as stepping stones toward universal healthcare. In 1969, Senator Edward Kennedy introduced the “Health Security” plan, a single-payer national insurance program offering care free at the point of service. President Nixon countered with his own proposal, which preserved private insurance but expanded coverage.

That debate was cut short by the 1973 economic crisis. Stagflation, coupled with the rising influence of corporate PACs, allowed business interests to redefine health policy. Corporate lobbyists insisted that universal healthcare was unaffordable. Cost control became the priority, and even Jimmy Carter’s healthcare plan was less ambitious than Nixon’s. What followed was a bipartisan embrace of neoliberalism and the steady erosion of public health services.

The 2008 financial crisis offered another opening for reform. The ACA’s passage in 2010 was a political achievement, yet it resembled Nixon’s market-based model more than Kennedy’s universalist vision. Some credit the ACA as a step toward revitalizing the system, but it left millions uninsured and kept the private insurance industry firmly in control of Americans’ health. OBBBA now attempts to repeal even those modest gains, leaving only a hollowed-out, privatized system.

The deepest legacy of the ACA—and of the broader neoliberal era—is not institutional but ideological. Healthcare came to be understood not as a right, but as a matter of consumer choice. You “buy” the coverage you can afford, just as you buy a car or a house. By slashing Medicaid and eliminating the last vestiges of public support, OBBBA entrenches the vision of health as a private commodity.

Healthcare reform has largely vanished from national politics. During the 2016 and 2020 campaigns, Medicare for All was hotly debated, propelled by Bernie Sanders’ insistence on universal coverage. By 2024, however, the issue had been pushed aside. Vice President Harris refused to endorse universal healthcare, and most Democrats offered only modest tweaks. In effect, healthcare has been deprioritized, even as costs climb and coverage deteriorates.

OBBBA marks the decisive end of a 50-year trajectory. The United States spends more on healthcare than any country in the world, yet access and outcomes remain dismal, stratified by class and race. With Medicaid gutted, vulnerable communities lose a resource essential for daily life. With wealth further concentrated at the top, the best predictor of health—income—is tilted even more steeply against ordinary Americans.

The law’s immigration provisions are rightly alarming, signaling a flirtation with authoritarian practices. But OBBBA’s restructuring of healthcare will shape daily life for far more people, embedding precarity into the very fabric of American society. It is the final blow in a long campaign, a dismantling of the idea that health is a public right, replaced by the cruel fiction that it is simply a matter of individual choice.