The Recently Passed Cuts to Healthcare Coverage for Poor Americans Hurt Every Taxpayer

Cutting primary care access for poor people is economic suicide

When it comes to healthcare, the big beautiful bill passed by the US House on May 22, 2025 was stupid and counterproductive. Be assured that I understand the federal budget deficit is a threat to our financial well-being and we must do something about it. Our leaders don’t understand that the best care is the least expensive care. They seem to believe that the only way to save money is to restrict benefits. They seem to believe that providing health care for you, takes money from them.

The Congressional Business Office (CBO) is strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence. They estimate that the "big, beautiful bill" would lead to nearly 14 million Americans losing their health insurance coverage by 2034. Specifically, CBO estimates that 8.6 million Americans would lose Medicaid coverage due to changes proposed by the Energy and Commerce Committee. Additionally, the expiration of enhanced premium tax credits under the Affordable Care Act could lead to a significant drop in marketplace enrollment, potentially impacting millions more

Other developed countries seem to have figured this out. They make certain that every person has access to a primary care doctor. The priorities of their healthcare system are not decided by Wall Steet. Because everyone has a primary care doctor, they receive care for their chronic diseases even if they are too poor to pay for it. On average, other developed countries spend half as much as we do on healthcare as a percentage of gross domestic product. They enjoy better health, and they live longer. In 2023, the United States spent approximately $4.9 trillion on healthcare, or $14,570 per person. This represented a 7.5% increase from the previous year. If we approached healthcare like other developed countries, we would save over two trillion dollars and that would take a great deal of pressure off the federal budget. Cutting coverage for poor people will not save money, it will cost more.

In other developed countries, everyone has access to primary care and that is especially important because chronic diseases generate 86% of costs and most premature death and disability. Not only do we spend twice as much on healthcare as over developed countries, that care is much less effective. The Wall Street Journal is no extreme leftist liberal newspaper. It is the paper most business executives read. This article— How Chronic Disease Became the Biggest Scourge in American Health -- from the journal is well worth your time.

Open the link and take a look! It is full of graphs that help you see this reality at a glance. Here is the lead quote from the article: “Americans live shorter and sicker lives than people in other high-income countries.” The first graph shows the most common chronic diseases in America. At number one, almost half of the adults in this country have high blood pressure. Fewer than half have their pressure controlled to less than 140/90. Kaiser Permanente achieves that in 90%. That is the benchmark. Treating high blood pressure effectively for pennies saves dollars spent on heart attack, stroke, congestive heart failure, chronic kidney disease, dialysis, and nursing homes. The best evidence says the blood pressure should be less than 130/80 for most patients.

The second most common condition is obesity at 40%. The most promoted medication to address that problem costs $1400 a month. If all obese Americans took that medication, it would wreck the federal budget. The third most common condition is diabetes at about 15% and 90% of those patients have type 2 diabetes. Best practice treatment for type 2 diabetes includes blood sugar control, blood pressure control, cholesterol control on a statin, no smoking cigarettes, and aspirin if the patient has artery disease or chronic kidney disease. Only about 20% of Americans with type 2 diabetes achieve those five goals concurrently. In Minnesota, some practices achieve those goals in 65% of their patients. That is the benchmark. The fourth most common condition is chronic kidney disease at about 15%. Most chronic kidney disease is caused by diabetes, hypertension, or a combination of both. These top 4 conditions are all related at the level of genetics, epigenetics, and molecular biology. Treating hypertension and diabetes effectively reduces the number of patients progressing to very expensive dialysis 6 fold. It is penny-wise and pound foolish. In plain English, it is stupid.

The next graph shows life expectancy at birth for developed countries. Leading the pack are Japan and Sweden at 84 years. The average for other developed countries is 84.5 years, and the US lags at 78.4 years. Other developed countries are steadily improving longevity while our longevity has slightly decreased, and we took a much bigger hit during the COVID. If you look at Americans aged 50-69, we lost 150 per 100,000 people while the rest of the developed world lost 50 per 100,000.

In the next graph, you can see that the death rate from cardiovascular diseases for Americans aged 50-69 is about 240 per 100,000 and in comparable countries it is 100 per 100,000. Our system that focuses on opening blocked arteries is the least effective in the developed world. The death rate from substance abuse is 4 times the rate in other developed countries.

The facts and the evidence are crystal clear. We are an outlier in every aspect of our healthcare system. We spend twice as much and have much worse results. That is the actual definition of a low value system and that is the reason our credit has been downgraded. One of the main reasons for that low value system is all Americans do not have access to the highest value healthcare providers— primary care. We may be great at developing new expensive medicines and devices that make more money for people who are already wealthy. We are terrible at providing care that works for patients who have chronic disease. I don’t just say how terrible our system is. In my next post, I will spell out how we can move from worst to first.

Make no mistake. Cutting support for poor people seeing primary care is a cure that is worse than the disease. Poor people are much more likely to have high blood pressure, obesity, diabetes and chronic kidney disease. Poor people much more likely to die or have devastating complications of those diseases. It makes no sense to deny them care in an outpatient primary care setting and then pay for their dialysis. Effective primary care prevents expensive heart attacks, strokes, kidney failure, heart failure, blindness, and amputation for pennies on the dollar. Cutting access to primary care is self-defeating behavior. Other countries get it, when will we figure it out?