Guest opinion.
For me, the midterm election of 2026 boils down to these two ideas.
The first is visceral: Donald Trump should never had a second term in the White House. He debases public life. He’s corrupt. And his policies are incomprehensible. It’s one thing to argue over conservative ideas; that’s fair and we can disagree about direction and policy. But a transactional president does not to that. He governs by whim. One day Russia gets all the marbles. Then a few weeks later he likes Ukraine again. Then Russia promises to sell a few days’ worth of diesel fuel and Russia is back on top. Same pattern for tariffs. Or well, just about anything except perhaps the rock solid support for the fossil fuel industry. That’s no way to run a country or manage an economy.
To read more articles by Mark Trahant, go to: Marktrahant.substack.com
The second issue is probably more important because it’s about the future of the country, and that’s the urgent need to rethink the health care system.
The back and forth between Peggy Flanagan and Michelle Tafoya at a debate last week is an ideal jumping off point for a broader discussion.
From the summary by MinneapoliMedia:
“Health care produced another substantial disagreement.
“Flanagan endorsed Medicare for All, arguing that Minnesota families face unaffordable premiums, deductibles and treatment costs.
“She described conversations with residents whose annual deductibles reached $16,000 and $18,000.
“Flanagan also called for eliminating prior authorization requirements that can delay medical treatment.
“She criticized decisions made by insurance administrators and automated systems that interfere with care recommended by medical professionals.
“Tafoya rejected Medicare for All as financially unrealistic, arguing that the proposal would require enormous federal spending and expand government control over health care.
“She instead called for reforms addressing hospital prices, pharmaceutical costs and insurance-industry practices.
“Tafoya said she would work with lawmakers from both parties to address those problems.
“Both candidates acknowledged that health care costs are too high. Their disagreement concerned whether the country should pursue a substantially different insurance system or focus on reforming existing arrangements.
“The debate did not establish the projected cost of Medicare for All or the potential savings from the candidates’ respective proposals.”
There is a lot here. But before we zoom and out and consider the larger picture, let’s examine something Tafoya said: Medicare for all is “financially unrealistic.” The problem is the system we have in place is “financially unrealistic.” It’s a crisis hitting state and federal governments’ books, as well as an uncontrollable cost for business and family budgets.
One by one, look at the facts. Last week the Commonwealth Fund reported its outlook for marketplace plans.
“For people who get their health insurance plans in the Affordable Care Act (ACA) marketplace, coverage became much less affordable in 2026. Insurers increased premiums by more than 20 percent; the average “benchmark” premium before tax credits jumped from $497 per month in 2025 to $625 in 2026.1 These increases were partly the result of actions federal policymakers took — for instance, slashing the tax credit some people received to reduce their health plan premiums and imposing new restrictions on enrollment. Predictably, as premiums rose and financial assistance shrank, consumers’ payments soared and enrollment dropped sharply.
“Consumers will get no relief in 2027. Insurers have proposed a median 15 percent rate increase for 2027, with significant variation across insurers and states. These back-to-back double-digit rate increases are the highest we’ve seen in the marketplace since 2018 and follow five years of relatively flat premiums, with average increases of only 2 percent per year for the benchmark plan. Insurer rate filings for 2026 and 2027 reveal that the federal policy changes to the ACA are contributing to these significant rate increases.”
A study by Georgetown University looked at the 2027 costs for employee plans (about half the total number of those insured now).
“Employer surveys and analyst projections point to a big jump in ESI costs in 2027, ranging from 9% to 11% before employers make any plan changes to manage their costs. This marks the largest annual increase in about two decades, and follows several years of elevated ESI cost growth.”
This is a problem growing worse. Again, from Georgetown.
“Workers’ deductibles have increased by more than 50% since 2015, outpacing wage growth and inflation. In 2026, the average deductible for workers with single coverage reached $1,886. Under the ACA, aggregate deductibles, coinsurance, and copayments are capped by a maximum out-of-pocket limit in most commercial market insurance plans. This cap helps protect people with significant health care needs from medical bankruptcy. However, the annual limit is so high–$10,600 for individuals and $21,200 for family coverage in 2026–that people with illnesses or injuries can still face staggering and unmanageable health care costs.
“Rising deductibles and high out-of-pocket maximums saddle many people with medical debt and drive others to skip needed and preventive care.”
The affordability of health care has nothing to do with fraud, waste and abuse (the favored Republican mantra). It’s structural and the solutions have to be systemic in nature.
This is a particularly thorny problem when Republicans do not see healthcare as a right (and when thinking about public health care, they see programs as welfare something for the “truly needy.”)
There is also the practical problem of unwinding a post-World War II mistake, tying health care insurance coverage to our jobs. It should be clear that the cost of that mistake that is threat to the nation.
Healthcare is unaffordable. For families. For companies. For states. And especially for the federal government. We spend more on health than any other country in the world without getting the benefits of universal coverage.
There has been a lot of talk about increased cost of interest and its impact on the federal government. It’s a big deal. Net interest on the debt crowds out spending that could be used for domestic or even military programs. But here’s the thing: Federal healthcare spending is growing even faster. Unsustainable numbers.
On the other side of the debate table, Peggy Flanagan mentioned that universal health care — Medicare for All — would save $1 trillion and save more than 60,000 deaths annually. That citation comes from a Yale University study.
“A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health.”
And the key point: We are already spending the money. It’s the allocation that has to change.
“Even with those limitations, the researchers argue that the United States already spends enough to provide universal coverage. The problem, they conclude, is how that money is allocated.
“A system that covers everyone, costs $1 trillion less, and averts more than 100,000 deaths annually requires no new discovery to implement, only enactment,” they wrote.”
This is exactly the debate the country needs to have now.
Potential impact on Indian health
After my last piece on universal health care, a friend of mine wrote to say he really likes the IHS service he has now. Like me, he’s an elder (which means Medicare covers a lot of the costs). And he wants to keep what he has.
I get that.
I have another story, though. When I had a Kaiser Health Fellowship I had a chance to spend some time at an urban Indian clinic in Detroit. The physician at the clinic went through all the steps he took — basically call after call — trying (read: pleading) with hospitals to get one of his patients admitted without insurance for speciality care. I remember thinking it was waste of that doctor’s time. I also thought, “what a hero!”
What if the Indian health system didn’t need to worry about the funding, only the practice of medicine? Imagine how much better it could be. Universal health care would by definition fully fund the Indian Health Service (And remember: 60 percent of the system now is run by tribes or nonprofits.) Agency clinics and hospitals would bill a single payer for services, no more Purchased/Referred Care. Just medical services.
There is a flip side to this: With universal health insurance, IHS or tribal clinics would have to provide a level of service that favorably compares to those medical facilities outside of tribal communities because tribal citizens could go anywhere. Competition.
Then that already exists for older people. We can take our Medicare anywhere we want. But as my friend pointed out — and it’s true for me, too — the service (and costs) are so much better at the tribal, IHS facilities.
It’s time to deliver and improve healthcare with Medicare for All.
