How Much Longer Will Americans Wait for Real Health Reform?, Health Care un-Covered, Feb. 20, 2026, by Trudy Lieberman
Kudos to Merrill Goozner, former editor of Modern Healthcare, for spotlighting a grim but important story on hisĀ Substack column GoozNews.Ā āA year spent degrading healthāĀ is a damning picture of the U.S. health care system ā¦
Below is an excerpt:
- Two snapshots of a health care system in precipitous decline: First, the latest Kaiser Family FoundationĀ tracking poll shows Americansā number one pocketbook concern is now the cost of health insurance and out-of-pocket health care expenses. Fully two-thirds of the public are more worried today about health care costs than food, housing, utilities or gasoline.
- Second, the Centers for Medicare and Medicaid Services reportsĀ that 1.2 million households dropped health insurance coverage during the 2026 sign-up season, a direct result of the Republican Congress ending the enhanced premium subsidies for Obamacare plan purchasers. The missing 1.2 million came from just 30 states that use the federal exchange.
ā¦ Now Medicaid, which was passed in the mid-1960s along with Medicare for the elderly, is in jeopardy because of provisions in President Trumpās One Big Beautiful Bill Act that reduced funding for the program.
ā¦ Will Americans pay medical bills for the rest of their lives while the profit concerns of big companies continue to overshadow the needs of ordinary Americans who just want a health system that takes care of their medical needs?
Comment:
By Jim Kahn, M.D., M.P.H.
This is, as a colleague aptly characterized it, a ācri de coeurā ā a painful and plaintiff cry from the heart, lamenting our dire situation. Who could have foreseen that Obamaās reforms and expansions to public and private insurance would leave hundreds of millions so deeply worried about health care costs? Many single payer advocates (myself included) said that the ACA tweaks were insufficient, costly and complex. But we (or at least I) failed to anticipate theĀ worseningĀ of health care financial woes.
As weāve often written in HJM, other wealthy nations (in the OECD) use a well-proven and clear strategy: a standardized comprehensive benefit package, with affordable cost-sharing, overseen by a public payer or a network of private insurers acting under not-for-profit rules. Thatās the formula. It works.
Why donāt we follow that model? As Trudy Lieberman writes, because of the interests of large corporations. They make tens of billions in profits, and impose many times that in administrative complexity. Hence decades of insurance tweaks at the margins. And with the new administration, retrenchments. More people are uninsured, and many more are under-insured, with sky-high deductibles and cost-sharing.
Yet, Iām optimistic. The pain so many of us feel with high health care costs and worsening insurance is registering widely as evidence of the abject failure of our current system. The collaborative response to the current administrationās excesses is building coalitions and empowerment. Progressive political candidates are surging. Several states are designing universal health plans.
This isnāt a post about technical insurance details (always time for that later). Instead, itās about staying the course, seeking and creating action openings. Health care reform bringing affordable universal coverage is in our future. It is for us to manifest through values and determination. And change strategy ā another technical topic, coming soon.
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