Not a day goes by without doctors, nurses, and patients alike agonizing over the infuriating reality of healthcare in the United States. I work at a primary care clinic that treats many undocumented immigrants and patients on Medicaid. On top of worrying about affording their medications, many of them are now terrified about losing their health insurance entirely or being met by ICE at the hospital doors. For many of us working in medicine, the crisis that the second Trump administration poses to our already broken system is becoming painfully clear.

The right wing has long been eager to cut Medicaid spending to offset the cost of their major tax cuts for the rich, and with Republicans in control of both houses of Congress and the White House, they are on the path to doing so. The projected cuts would mean that more than 600,000 people will lose coverage for medical services like routine doctor’s visits, dental cleanings, or emergency procedures. States recently stripped 25 million people of Medicaid coverage by rolling back the pandemic-era expansions that had provided temporary relief, leaving nearly 8% of Americans uninsured. 

But U.S. healthcare was a mess even before Trump 2.0. The dysfunction in healthcare stems from it being run for profit, making it a system riddled with inefficiencies, sky-high costs, and bureaucratic headaches. 

The U.S. spends the most on healthcare worldwide and yet has very little to show for it. U.S. life expectancy is projected to rank only 66th globally by 2050, dropping from 49th in 2022. High rates of preventable diseases like heart disease, stroke and diabetes are keeping Americans sick and making a few very rich. 

For the majority of people who do have some form of health insurance, it is a nightmare to navigate and an enormous financial burden. In 2023, the average worker with employer-sponsored insurance shelled out $8,435 in premiums, while families faced a staggering $24,000 price tag for coverage. And that’s before co-pays, deductibles, and surprise bills. When getting sick can mean financial ruin, it’s clear that the system doesn’t work for us. 

Big Pharma, health insurance companies, and hospitals all line their pockets by overcharging us as patients, and by limiting what treatments and procedures we can access—but this is the logic of healthcare under capitalism. The result is a purposefully inefficient system that rewards the rich for keeping people sick, rather than preventing illness in the first place. 

Cures Aren’t Profitable

Insurance companies are perhaps the most crooked expression of this system. The widespread celebration of the assassination of the United Healthcare CEO speaks to the anger in society bubbling just under the surface, not only for the ludicrous cost of healthcare, but for the insurance companies’ brazen willingness to deny claims and coverage to people during some of the most vulnerable experiences of their lives. 

These companies serve no purpose except as expensive middle-men between patients and healthcare providers. They dictate what types of care patients are allowed to receive, very often against the doctor’s medical opinion, while scrutinizing our bills and playing no role whatsoever in medical treatment. As a result, many patients either incur large amounts of medical debt, go under-treated, or get no care at all. This is not news to working people. There are far too many cases of patients dying as a result of insurance companies denying or delaying coverage of necessary medical treatment.

Hospital CEOs and shareholders also make a killing off of their patients. Hospitals gear much of their services towards medical specialties that perform expensive procedures and surgeries. Putting massive resources into high-yield specialties, like cardiac surgery, comes at the expense of primary care jobs that prevent you from having a heart attack in the first place.

Even so-called “non-profit” hospitals, which make up nearly half of all hospitals in the U.S., are run like businesses. They get massive tax breaks from the IRS to supposedly invest in “community benefit” and provide cheaper or free services to poorer patients. However, most non-profits operate on a capitalist business model. They pay their CEOs millions and spend massive budgets on shiny new facilities, all while hiring consultant firms to devise ways of making more money off of patients, including schemes to make poor patients pay what they legally shouldn’t have to. 

But when it comes to making people pay needless sums of money, Big Pharma takes the cake. A 22-year-old recently died in Wisconsin after being unable to afford asthma meds that had increased by $500! The industry makes enormous profits by keeping medications expensive. Insulin was first patented in 1923 but is continually reformulated and repatented to keep the price controlled by a monopoly of only four companies. This leads to patients rationing their insulin, which can quickly result in medical emergencies or death. 

This even affects generic medicines, where monopoly control of medications by only a few Big Pharma companies allows them to fix prices without fear of being undercut. Vyera Pharmaceuticals raised the cost of a generic treatment for toxoplasmosis, an infection that risks miscarriage and stillbirth in pregnancies, from $13.50 to $750 a pill. While pharmaceutical companies jack up prices for working people, they also openly admit that finding actual cures is “not a sustainable business model” (Goldman Sachs in a report on gene therapy research in 2018). 

Fight For Universal Healthcare

The dysfunction of the U.S. healthcare system is not an accident—it is the direct result of a system that prioritizes profit over human lives. This is the logical extreme of healthcare under capitalism: a handful of CEOs and shareholders reap obscene wealth while millions suffer, go without care, or drown in medical debt. 

But since the COVID-19 pandemic, there has been a wave of labor struggles in the healthcare industry. From the historic 301-day St. Vincent nurses’ strike—the longest nurses’ strike in the last 15 years—to the 3-day, 75,000-strong Kaiser Permanente strike, healthcare workers have been on the front lines of ongoing fights for safe staffing ratios and higher wages, demanding better conditions for ourselves and our patients.

When hospitals are adequately staffed, when doctors and nurses are not overworked, and when profit-driven cost-cutting measures are beaten back, it’s the patients who benefit. But as Republicans prepare devastating attacks on Medicaid and healthcare access, and the Democrats refuse to fight, unions cannot afford to stop at just workplace demands. 

Unions must take up the broader fight for universal healthcare—a fully public healthcare system that guarantees care for everyone, not just those who can pay. The National Nurses United (NNU) has long championed Medicare For All, but these efforts must be scaled up into a serious mass movement. 

The reality is that society has more than enough resources to provide free, high-quality healthcare to everyone. The only reason it doesn’t is because of capitalism—a system that treats our health as just another commodity, not a human right. The fight for universal healthcare is a fight against that logic, one that working people, led by organized labor, must take up with urgency. But winning real, lasting change requires more than just reform—it means overthrowing the entire rotten system and fighting for a socialist alternative where our health comes before corporate greed.