By Joseph Q. Jarvis | Published: 17 July 2026
Jonathan Chait published an “Ideas” piece on July 15, 2026 in the Atlantic Monthly that said one thing, only, that I can agree with: “American politics is, to a very substantial degree, a fight over health care.” The remainder of the article is just wrong, which is why I am not offering a link here to the article. I don’t want my readers to read what Mr. Chait otherwise opines, for reasons I will discuss briefly below. But first, why I agree with that one statement.
The dominance of health care as the quintessential, signal, overriding domestic issue in the US should be obvious to everyone. Only in the US (among wealthy nations) do everyday average patients find themselves priced out of medically necessary care, and die prematurely (a reasonable estimate is that 200,000 unnecessary deaths occur each year in the US do to dysfunction in the US health care system). Only in the US is the cost of care for illness and injury the leading cause of personal bankruptcy (most who look into this estimate that 500,000 bankruptcies each year, or 60% of the total, are caused by health care costs). As much as 20% of the unhoused in the US are homeless because illness and injury costs robbed them of the funds needed to pay for a roof over their head. American seniors who need long term care find themselves having to spend down their assets, including the equity in their home, in order to qualify for long term care financing. Prices for pharmaceuticals and surgeries, and medical devices, etc. are two to ten times higher in the US than elsewhere in the world, and force untold numbers of Americans to decide between eating, paying for utilities, buying gas for the car to get to work, etc. and taking medicine or getting other needed care. Virtually all of the federal deficit on into the foreseeable future is due to forecasted health care spending. The percentage of the US Gross Domestic Product that is spent on health care is approaching 20%, will cross that threshold probably before the beginning of the next decade, and, at that level of spending, will threaten the entire US economy, big as it is. That problem only exists in the US. No other country allows the health care industry to starve other economic necessities of funds.
These facts about American health care have been essentially true for decades now. Health care costs have been the leading issue on the minds of American voters for many election cycles. Health care costs are the leading issue in the current midterm election cycle. Since Bill Clinton came to office, no first term American president has come to the office initially without running on health care in some important way. American voters know that they are one illness or injury away from bankruptcy, or finding themselves unable to pay for needed care, and they want to hear what their candidates have to say about that. Even Donald Trump has felt compelled to repeatedly assert that he has a plan for health care. Primeval fears like these can easily be exploited by politicians, and that is exactly what has happened over and over again, and is happening now. Remember Harry and Louise? Death panels? Immigrants coming for your health care? Socialized medicine?
American taxpayers pay more taxes to support health care programs than do the citizens of any other country. That’s because we Americans want people to get health care when they need it. Hill-Burton funds (from the federal government) built many hospitals across rural America (which are now closed or closing). Teddy Roosevelt was the first president to openly talk about universal health care. His cousin, Franklin, actually tried to get it passed by Congress. As did Truman. Seeing their failure, LBJ settled for Medicaid and Medicare rather than universal care, health financing respectively for the poor and the elderly who had been abandoned by for-profit health insurance. Clinton signed CHiP into law, a federal-state shared program for health care financing for children. George W. Bush expanded Medicare to cover the prescriptions needed by seniors. And Obama, famously, passed the poorly named Affordable Care Act. But there are literally thousands of other public health programs and initiatives that have been created to put a finger in the leaking dam that is the American health care system. And I haven’t even begun to point out how much has been spent by the federal government to fund the research needed to improve health care, train doctors and nurses, and prevent injury and illness from happening in the first place.
One would think that with all this effort and spending on health care Americans would be admirably cared for, even if at great expense. But one would be wrong to think that. As Mr Chait says, American politics remains in large measure a fight over healthcare.
Whole areas of the country go without needed care, especially in rural and poor urban America. That leads to unnecessary illness and death, of course, in those abandoned areas. But, there are economic consequences as well. When you remove 20% of the gross domestic productivity from a geographic area, you also remove the revenues and incomes that come with that activity. Rural economies suffer without those white collar jobs. As the flaws in American health policy have eliminated the care and the economic power of health systems from rural and frontier areas of the country, half the population of the US has awakened to the reality that their taxes are paying for the kind of care that they can’t have in their own county. And those voters have become angry. The immediate cause of the anger leading to the Tea Party revolt was losses associated with the Great Recession, for which Wall Street interests were never made accountable. But giving the health care store away to the corporate health interests in the form of the badly named “Affordable Care Act” shortly thereafter reframed the anger of the Tea Party into the more permanent MAGA crowd, which Mr. Trump discovered and has consistently exploited for a decade.
Here’s where Mr. Chait’s article comes in. He has written this piece with the thesis that the progressive wing of the D party is wrongly accusing the mainstream Ds that they do nothing about health care. But he makes an error in this article; he conflates the ability to get health care with having a health insurance plan. His entire argument about how the mainstream D party supports universal health care is based upon the notion that Obamacare was a step toward universal care because more people having health insurance means fewer left out of health care. WRONG. Private for-profit health plans used the Affordable Care Act to make actual care so unaffordable that a new health policy term had to be invented to name the subsequent problem-functional uninsurance (what happens when tax payer subsidized premiums are paid so that less well off families can have health insurance but then these families can’t pay the coinsurance or deductible so they can’t afford the actual care anyway).
Mainstream Ds can become quite offended when I fault Obamacare for its failures. They are incensed that I’d criticize Mr Obama who they hold in such high regard. But Mr Obama knew very well that single payer was the only choice which could actually achieve the goal of universal health CARE. He once held a press conference to that effect while serving as a state senator. It’s just that the fight to get single payer would have put him at odds with the medical industrial complex—the single biggest sector contributor to D politics (and R too). Mainstream Ds, particularly the well heeled corporate elite (eg Nancy Pelosi) will not fight that lobby. They will give them anything they want. And that’s exactly what Obama did. Before he was sworn into office after winning in 2008 he cut a deal with the medical industrial complex and gave the store away. That is documented in the Frontline documentary “Obama Deal”. That deal was a huge windfall for health insurers. Their stock values increased by an order of magnitude (10 fold) from the day Obama signed the ACA into law until the day Biden was sworn into office as president.
Mr Chait’s article simply skips over all discussion about how wrong American health insurance is. It’s dishonest. Ds are as much the problem with health care failure in the US as are Rs.
For more information about this, please read my book “The Purple World: Healing the Harm in American Health Care”.
So politics in the US remains a fight over healthcare. You must choose a side in this fight. Your vote will count this year. Your donations will matter, whether small or large. Republicans obviously have nothing to offer on healthcare. Trump has never actually had a plan and his signature “beautiful “ bill is stealing funds from healthcare and enriching the wealthy. Mainstream Ds only offer what’s good for the profits of the medical industrial complex. I’d suggest you begin your political fighting this year by withdrawing support from incumbents.
In Utah we have drafted a bill-The Utah Cares Act-which will create better, simpler healthcare financed fairly for all. We tried to run it through the legislature but couldn’t even get a hearing. We plan to put it on the ballot in 2028 after not being allowed to enter it on the ballot this year. This ballot initiative will end the political fighting over healthcare. Stop funding politics as usual and instead this year donate whatever you can to get the Utah Cares Act on the ballot. If Utah succeeds (like it did with medical marijuana, Medicaid expansion, and gay marriage) then better, simpler healthcare for all will march forth from Utah to the rest of the nation.
Join this fight. Give what you can. Stop what you are doing and go to View source at utahcares.health and make your voice heard.
Thanks.
Dr. Joseph Q. Jarvis is a public health physician, chair of the Utah Cares Political Issue Committee and author of several books, including The Purple World: Healing the Harm in American Health Care and What the Single Eye Sees: Faith, Hope, Charity, and the Pursuit of Discipleship.