The One Big Beautiful Bill Act (OBBBA) lays bare a brutal truth about American health care: when coverage depends on politics, paperwork, employment status, and state budgets, people lose care—and some will die because of it. Cuts and administrative barriers to Medicaid, new hurdles for Affordable Care Act marketplace coverage, and continued failure to guarantee stable access to care all point in the same direction: our fragmented system is not merely inefficient. It is dangerous.
For families already postponing prescriptions, rationing insulin, skipping follow-up appointments, or delaying cancer screenings because of cost, the consequences are immediate and cruel. Eligibility checks, work reporting requirements, narrowed enrollment windows, and higher premiums do not make people healthier; they make people uninsured. They push patients out of primary care and into emergency rooms. They weaken rural hospitals, safety-net clinics, physicians, nurses, and communities that are already being asked to do the impossible with too little support.
That is why this moment demands more than defensive politics. We cannot simply plead for smaller cuts, fewer barriers, or temporary patches to a broken system. We must fight for the system patients actually need: Improved Medicare for All. Improved Medicare for All would guarantee comprehensive coverage for every person in the United States, regardless of job, income, age, health status, or zip code. It would replace a maze of private plans, deductibles, denials, and eligibility traps with a public program that covers care because care is a human need—not a commodity.
Opponents of Medicare for All ask how we can afford it. That question has it backward. How much longer can patients, workers, employers, hospitals, and taxpayers afford the waste, profiteering, and cruelty of the system we have? We already pour enormous sums into premiums, copays, deductibles, billing departments, insurer profits, and administrative waste—while millions remain uninsured or underinsured. A single-payer Medicare for All program would redirect those resources toward care, prevention, medications, mental health services, long-term care, and the health professionals who provide them.
This is not because the United States spends too little on health care. It is because we tolerate a system that spends lavishly on bureaucracy and profit while denying people care. The U.S. spends nearly twice as much on health care as the average comparable high-income country yet remains an outlier without universal coverage and with worse results on measures such as life expectancy, avoidable deaths, maternal and infant mortality, affordability, and access. Other industrialized nations have proved that universal coverage is possible. Our failure is not medical. It is political.
The OBBBA should be treated as a warning siren, not a passing headline. If health care can be taken away through budget cuts and bureaucratic obstacles, then health care is not yet a right. Medicare for All is the path to making that right real—stable, universal, equitable, and accountable to patients rather than insurance companies.
Join us on Wednesday, August 27, for a National PNHP meeting on why this moment demands an aggressive, unapologetic push for Medicare for All. We will discuss the damage caused by the OBBBA, the threat it poses to patients and communities, and the role that physicians, health professionals, patients, students, and advocates can play in building the power needed to win a universal, publicly financed health care system.
Register today at PNHP.org/aug27.
Dr. Bruce Silverman is a retired physician and the Volunteer Medical Director of GoochlandCares, a free clinic serving uninsured residents of Goochland County, Virginia. He is also the Legislative Chair of the Virginia Chapter of Physicians for a National Health Program. The views expressed are his own.
Take Action
- Register for the August 27th National PNHP meeting
